Shortness of breath (dyspnea): causes, diagnosis, therapies

Difficulty breathing (shortness of breath, dyspnea) is the feeling of difficulty breathing, which is often frightening. The causes, especially lung and heart diseases, are diverse and sometimes life-threatening

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Breathing and shortness of breath: Info in advance

  • Breathing: Healthy adults breathe in and out about 15 to 20 times per minute (resting frequency). It is around 30,000 breaths per day. Breathing is regulated in a complex manner. The lungs and breathing muscles ("external breathing") as well as the blood and body cells that use the oxygen ("internal breathing") are involved. The supreme controlling authority is the brain. The exchange of carbon dioxide for oxygen in the alveoli has a key function in breathing (see also the picture gallery in the chapter "Causes of dyspnoea: lung diseases").
  • Natural "breathing space": Emotional factors such as anxiety attacks, fright, rising anger or pleasant surprise immediately affect the breathing: it can increase briefly but violently (hyperventilation), or the breath comes to a standstill. Shortness of breath occurs in the early and late stages of pregnancy, each for different reasons. Physical exertion also temporarily increases breathing. The level of training makes the difference: competitive athletes have a much larger reserve of air than average active people.
  • Unfavorable influences: Posture, body position, body structure: In a slumped posture, we breathe passively and shallowly. Breathlessness can increase when lying down - many heart patients are familiar with this. Elevating the upper body usually brings them relief. With bronchial asthma, the "coachman's seat" often helps those affected to get more air (see picture below). A deformed skeleton or very overweight (obesity) can make breathing difficult.
  • Different duration: shortness of breath can occur acutely, for example in the case of pneumonia. Difficulty breathing for more than four weeks is called chronic. Depending on the cause, acute attacks can also occur.

Free flowing breath: fresh energy step by step

Breathing usually goes by itself. But we can also take in the air very consciously with a deep breath and use it in a targeted manner - for example to feel ourselves more strongly. Or while singing and dancing. And if you have perfect breathing techniques, you have very good prerequisites to bring it to vocal or physical expressiveness.

The opposite is shortness of breath (dyspnea), which does not mean breathlessness after strenuous physical exertion, but any breathing that is not normal to pathologically difficult, including shortness of breath.

Short of breath during physical exertion, breathless during stress?

Breathlessness is common within certain limits. Sometimes we feel a bit breathless when we are under a lot of stress. The willingness to react, which is in our genes, increases the pulse rate and breathing rate. The feeling of breathlessness is on the one hand the expression of being driven. But it also has a physical equivalent, because many of us literally no longer take the time to consciously breathe deeply when we are under stress. They do this superficially and often in an awkward position. That doesn't exactly stimulate the flow of breath.

Overall, however, the breathing system functions normally in these situations. However, it would be important to get the stress under control, as well as any excess weight and sagging muscles, so to speak "weakness factors" when breathing. If you get your body going, you will cheat all three.

Panting for air after a strong athletic performance is also normal. Many people know that: If you don't have enough training, you only have enough breath for a short sprint. Athletes, on the other hand, often have some space left for a brisk interview after a top performance.

Gas exchange takes place via the alveoli and the connected vessels

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Shortness of breath is one of the most common symptoms

About 25 percent of outpatients treated with dyspnea are receiving medical treatment. No wonder, because heart and respiratory diseases - the main symptom of shortness of breath applies to both - are widespread. The close connection between the functions of the heart and lungs reinforces this effect.

Difficulty breathing (dyspnea) occurs - on the physical level - as a result of disorders

  • During air transport, i.e. when the air is moved back and forth in the respiratory tract (disruption of the so-called breathing pump; the respiratory muscles and the elastic chest with the pleura are particularly important here)
  • During gas exchange: affects the alveoli, the connective tissue between them, the blood and the blood vessels involved
  • in respiratory regulation (brain: higher-level centers, respiratory center, body impulses)

As is well known, a shortage of air can wrap itself around the chest like armor. Of course, this creates great fear or panic and often makes the situation worse. Regardless of the body processes involved in the development of shortness of breath, the psyche must always be taken into account. Therefore, in acute cases, always calm the affected person until the doctor arrives.

What to do if you are short of breath?

Very clear: In the event of a sudden severe or increasing shortage of breath, you should immediately alert the emergency doctor (ambulance service, emergency number 112). Often shortness of breath characterizes chronic diseases such as asthma, obstructive bronchitis, heart failure and accompanies them more or less constantly and with varying degrees. It can deteriorate acutely at any time.

If this is the case, if there are additional warning symptoms (see below) or severe shortness of breath for an unclear cause, emergency treatment and hospitalization is essential, possibly life-saving.

As a patient with an illness that can lead to acute breathing problems, stick to a plan that you have set out with your doctor precisely for this case. This also includes using a possible emergency spray and other medication as prescribed. Keep calm, maintain an upright posture that makes it easier to breathe.

If you immediately feel relief from the emergency medication - if you have a known respiratory disease - and your overall condition improves again, the doctor called will consider whether it can be done without hospital admission for the time being. Is the previous therapy sufficient or should it be adapted? The attending physician will then check this. The shortness of breath often improves with temporarily intensified treatment and accompanying measures.

Diseases of the respiratory tract and lungs: shortness of breath is a key symptom

In addition to coughing - with and without sputum - and chest pain, shortness of breath is one of the main symptoms of diseases of the respiratory tract, including the lungs. Anyone dealing with bronchial asthma, for example, often feels resistance when breathing, especially when breathing in or out. Exhaling can also be audibly difficult and prolonged here.

A pulling or whistling noise when you inhale, on the other hand, can indicate an obstruction of the major airways, such as the windpipe. Such an obstruction can arise inside the windpipe or from outside pressure: both are emergencies.

This also applies to acute respiratory distress syndrome (ARDS). It can develop if someone suddenly has lung damage with severe oxygen deficiency and shortness of breath, for example in the course of pneumonia or inflammation of the pancreas, after heart surgery, through injuries, smoke inhalation, burns or if gastric juice has got into the airways.

Certain vascular diseases, such as pulmonary embolism, pulmonary hypertension or the comparatively rare connective tissue inflammation in the lungs, can also impair respiratory function.

Listening to the heart and lungs can give the doctor important information

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Heart disease: Here too, shortness of breath is an important symptom

Heart disease patients often suffer from shortness of breath. If, for example, a weakened heart no longer pumps enough blood into the large circulation - this is also possible in the event of a heart attack - fluid from the blood can build up in the lungs. This affects gas exchange and increases the tone of the small bronchi.

If the doctor listens to the patient's lungs with the stethoscope, he may notice abnormal breathing noises, a crackling of fine bubbles or even whistling and humming, as is actually typical for bronchial asthma. Doctors actually know the - meanwhile outdated - term cardiac asthma (asthma cardiale) in connection with cardiac insufficiency. So sometimes shortness of breath can be the only symptom of a heart attack.

Many other causes can impede the flow of breath

Other possible triggers of shortness of breath are disorders of the brain, nerves and muscles or respiratory muscles. So-called autoimmune systemic diseases such as collagenosis, in which the connective tissue in various organs becomes inflamed, can also impair breathing if breathable tissue is damaged.

In addition, acute allergic reactions, metabolic disorders, diseases of the blood such as anemia and the skeletal system, such as deformations of the chest including the thoracic spine, can interfere with breathing. This also applies to injuries such as broken ribs and changes in the lungs caused by poisoning or medication.

With a fever or an overactive thyroid gland, oxygen consumption is increased, which can cause shortness of breath.

Problems with the vocal cords also play a role, as does chest pain. This in turn can have numerous causes. This also includes a disease called fibromyalgia syndrome with chronic pain and a variety of other complaints, including shortness of breath. The list does not end there.

Because shortness of breath can sometimes also be an (unconscious) expression of a deeper emotional burden. Here, too, professional help is important, for example in the form of psychotherapy, so that the problem does not get stuck.

Other warning symptoms

In addition to shortness of breath, depending on the cause, other alarm signals can occur and exacerbate emergency situations:

  • Abnormal breathing sounds, fast, shallow, or decreased breathing
  • Because of severe shortness of breath, breathing is only possible with an upright upper body and supported arms (orthopnea)
  • Cough, possibly bloody sputum
  • Blue rash (cyanosis): blue-purple discoloration of the skin, lips, nails and / or mucous membranes, tongue
  • Blood pressure very high or very low
  • Chest pressure and tightness
  • Irregular, fast, or very slow heart rate
  • Impaired consciousness
  • Cold sweat, restlessness, tremors
  • Wheals on the skin with redness and itching
  • Chest pain (with or without breathing)
  • Swelling of one or both legs (edema)
  • Swelling of the lips and lining of the mouth
  • Severe dizziness, fainting, pronounced weakness