What Are Breathing Difficulties? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Feeling as if it’s hard to catch your breath for a minute or two is not unusual, especially if you’ve been exercising or doing similar activities such as vigorously cleaning the house or carrying heavy bundles. That’s because when we exert ourselves, our muscles require more oxygen than they do when we are at rest. Our breathing rate momentarily quickens, and our heart beats faster to meet that need.

But if it’s hard to catch your breath for longer than a few minutes, it may be due to other causes. Oftentimes, those causes are easily fixable or explainable. You may, for example, simply need to loosen a too-tight belt or take it a little easier after spending a long time in bed.

In other cases, however, breathlessness — what doctors call dyspnea — may signal the presence of an underlying health problem such as a respiratory illness, heart disease, allergies, or obesity.

“Just feeling tired or feeling worn out or weak is not shortness of breath," says pulmonologist Roger Maxfield, MD, a professor of medicine at Columbia University Medical Center in New York City. "And even if you feel like you can’t get enough air for a little bit after an activity, that’s okay. But if you’re short of breath at rest or you’re breathing as hard and deep as you can and you just don’t get enough air, that’s something that requires professional medical attention.”

In addition to feeling as if you cannot take in enough air, symptoms of dyspnea, according to the journal American Family Physician, can include the following: (1)

• Rapid breathing
• Increased heart rate
• Gasping
• Anxiety or panic, which can make breathing even more difficult

How can you know if your shortness of breath warrants medical attention? “If you can speak full sentences comfortably, then it’s likely not a medical emergency,” says family physician Sachin Nagrani, MD, medical director of the national healthcare company Heal. “But it is something that generally should be evaluated by a medical professional due to the range of things that can cause shortness of breath.”

If you have a chronic condition associated with breathing problems such as chronic obstructive pulmonary disease (COPD), a certain level of breathlessness may be normal for you, adds Geoffrey Mount Varner, MD, an emergency room physician in the Washington, DC, metropolitan area. Any worsening of preexisting symptoms, however, is cause for concern. “If you often experience feeling winded when you walk to your refrigerator, for example, most likely there’s nothing to worry about,” Dr. Varner explains. “But if shortness of breath is getting worse — if you noticed you get it when walking to the refrigerator and now you also feel shortness of breath when sitting, that’s a sign it needs a doctor’s attention.”

The Mayo Clinic advises you to call a primary care doctor if shortness of breath meets these criteria: (2)

• Is new to you
• Happens sooner or is worse than usual after exercise or other activities that you used to handle with ease
• Is accompanied by swelling in your feet and ankles, high fever, chills, wheezing, or cough
• Occurs or gets worse when you’re lying down (a symptom called orthopnea)

Varner stresses that you should call 911 or head to the emergency room if your shortness of breath progresses to one of these levels:

• Is persistent while sitting or at rest
• Is severe enough to interfere with daily living or function
• Is paired with chest pain or pain that spreads to your arms, neck, jaw, or back; dizziness or confusion; or bluish lips or nails (all may be signs of a heart attack or pulmonary embolism)

The first thing your doctor will do, explains Maxfield, is take a medical history that will include the following questions:

• When did your breathing difficulties start, and was the onset abrupt or gradual?
• How long have your breathing difficulties lasted?
• Did anything trigger your breathing difficulties or worsen them, such as allergens, extreme temperatures, or lying down?
• Have you experienced other symptoms? For example, dyspnea coupled with swelling in the feet and legs might indicate heart failure; high fever would usually signal an infection; and chest pain could be cardiac related or associated with a blood clot in the lung.
• What medications are you taking, and do you have a history of smoking, high blood pressure, lung or heart conditions or disorders, or risk factors for pulmonary embolism, such as recent surgery or long-distance travel?

Next, he says, your doctor will perform a physical exam, observing your breathing patterns, listening to your lungs and heart, and looking for fluid retention and signs of swelling.

Your doctor may also do these tests:

• Draw blood to test for signs of biomarkers of underlying conditions like heart disease.
• Measure how much oxygen your blood is carrying with a painless sensor (pulse oximeter) placed on the fingertip. Too little oxygen can be a sign that the lungs are not functioning properly.
• Perform an electrocardiogram to check for signs of heart or lung disease; do other tests to measure lung function and air flow; or order a chest X-ray to look for evidence of a collapsed lung, pneumonia, and other lung and heart abnormalities.

The diagnosis and treatment of dyspnea is sometimes made more difficult by the presence of more than one underlying health problem, which can happen often in older people. (14)

Overall, shortness of breath is one of the most common of all medical complaints. It accounted for more than 7 percent of visits to hospital emergency rooms and as many as 25 percent of office visits to general practitioners, according to a report in the December 2016 issue of Deutsches Ärzteblatt International, the German Medical Association's international bilingual science journal. (14)

That number is certainly higher since the novel coronavirus (SARS-CoV-2) pandemic has driven more and more people to hospitals, says Maxfield. However, it’s important to recognize that “difficulty breathing can be caused by many things other than COVID,” says Dr. Nagrani.

Favorite Orgs for Essential Info About Breathing Difficulties

American Lung Association
The ALA is considered the leading nonprofit for learning about lung disease prevention, as well as symptoms, causes, and treatments. Sign up for its free newsletter for the latest news about lung health (including COVID-19) and research, inspiring stories, and resources. If you're looking to quit smoking, the ALA’s Freedom From Smoking Plus feature can help you create a personal quit-smoking plan on your desktop, tablet, or smartphone.

American Thoracic Society

The ATS is a go-to resource for reliable patient information on topics ranging from asthma and breathlessness to rarer lung diseases, such as obesity hypoventilation syndrome, and other adult and pediatric respiratory diseases and disorders.

British Lung Foundation

One of our favorite features from the British Lung Association is its web community, where you can chat online 24 hours a day with people experiencing shortness of breath and other lung-related symptoms.

Favorite Site for Becoming a COPD Advocate

COPD Foundation

If you’re looking for a way to make a difference, consider joining the foundation’s COPD Action Center, which works with local, state, and federal policy makers to increase research funding, improve care delivery, protect access to treatments, and create policy that improves the lives of those with COPD. You can also enroll in the organization’s COPD Patient-Powered Research Network to stay up-to-date on clinical trials and share your experience and health information with researchers to help deepen their understanding of the disease.

Favorite Apps

The Breathing App uses fun interactive features to help guide you as you learn to breathe more deeply at your own pace. You can choose between watching a ball expand as you inhale and get smaller as you exhale, a clock that counts up on the inhale and down on the exhale, or if you like to breathe with your eyes closed, musical cues to match your preferred breathing pattern. Practicing deep breathing can help maintain and increase your lung capacity, so it’s easier to keep your lungs healthy and get your body the oxygen it needs. It reduces stress, too!

Medisafe is a free app that helps you manage any medications you take, including those to treat chronic conditions that may cause shortness of breath. It reminds you when to take each of your meds, alerts you to potential drug interactions, and notifies you when your prescriptions are running low. The information can also be shared with your healthcare team and pharmacy.