Causes of shortness of breath

Since shortness of breath, or dyspnea, is not always a consequence of pathological processes in the body, it is divided into physiological and pathological variants. Thus, physiological dyspnea is a normal compensatory mechanism that is triggered by a forced oxygen deficiency - for example, with excessive physical exertion. But the pathological variant of shortness of breath is the result of disease processes. For example, shortness of breath can manifest itself in diseases of the cardiovascular system, respiratory tract, etc.

The most common causes of shortness of breath:

• cardiac asthma and pulmonary edema,
• pulmonary embolism,
• spontaneous pneumothorax,
• bronchial asthma,
• psychogenic causes.

Psychogenic causes

Some people may have attacks of psychogenic dyspnea. In these cases, for unknown reasons, there is a feeling of shortness of breath that is not associated with heart failure. As a rule, shortness of breath is preceded by a feeling of unmotivated anxiety or fear. The patient begins to breathe deeper and more often, but at the same time the chest is not able to expand enough to take a deep breath. As a result, the feeling of shortness of breath and shortness of breath intensify, dizziness is often noted, and some patients may even have a pre-syncope condition. Such shortness of breath is usually called hyperventilation syndrome. Psychogenic dyspnea itself is safe. In a mild form, many healthy people experience such attacks during excitement or anxiety. Usually in the form of an inability to breathe as deeply as desired, or simply in the form of involuntary sighs.

From the clinical and pathogenetic positions, psychogenic dyspnea should be distinguished from hyperventilation syndrome, in which it can be one of the leading manifestations. The presence of (subjective) breathing difficulties usually causes a desire to get rid of dyspnea by increasing breathing, which, as a rule, increases the feeling of respiratory discomfort. Consequently, the connection between psychogenic dyspnea and hyperventilation is very close, and only the duration of the dyspnea phenomenon and its severity can play a role in whether it is combined with compensatory hyperventilation or with an already developed hyperventilation syndrome - a fairly deep and multidimensional, persistent pathological condition.

Apparently, psychogenic dyspnea in its "pure" form (i.e. without concomitant hyperventilation) is rare. However, in the presence of respiratory discomfort at rest in a patient without organic changes in the nervous and somatic (including pulmonary) spheres with calm breathing, without signs of hypocapnia and blood alkalosis, the diagnosis of psychogenic dyspnea is quite legitimate.

Pathological causes

Shortness of breath usually begins during physical exertion, which is typical for the early stages of various diseases, when previously easily performed loads gradually become less bearable.

The symptom of shortness of breath is often associated primarily with pulmonary diseases, although this clinical sign occurs with approximately the same frequency in heart diseases. In addition, shortness of breath can occur with obesity, severe anemia, intoxication, and also have a psychogenic nature (for example, with hysteria - in this case, it is more appropriate to talk about hyperventilation). Therefore, if a patient complains of shortness of breath, first of all it is necessary to find out with what system's pathology it is mainly associated.

During physical exertion of sufficient intensity, shortness of breath occurs even in healthy people. This feeling of shortness of breath during exertion is familiar to everyone. In heart diseases, shortness of breath begins to appear even during normal daily exertion, forcing the patient to move at a slower pace.

The most common cause of shortness of breath during exercise is detraining. Everyone will experience shortness of breath during exercise sooner or later if they do not maintain physical fitness.

The same shortness of breath is observed in obesity. Moreover, obesity and detraining often go together. Shortness of breath can be a sign of lung disease. The most common cause of chronic, constant shortness of breath is pulmonary emphysema.

Patients with severe heart damage due to heart failure, due to damage to the left parts of the heart (left ventricular failure), experience attacks of shortness of breath at rest. Most often, these are attacks of the so-called paroxysmal nocturnal dyspnea. These attacks are often called cardiac asthma (during attacks, dry wheezing caused by bronchial edema is heard). In typical cases, the patient falls asleep, but wakes up after 2-5 hours due to a feeling of shortness of breath caused by venous congestion in the lungs. In a sitting position or when walking around the room, the attack passes in 30-45 minutes. If you take nitroglycerin, the attack of cardiac asthma passes faster. Patients with attacks of nocturnal dyspnea, as a rule, cannot stay in a lying position for a long time due to difficulty breathing due to a rapid increase in venous congestion in the lungs. This condition is called orthopnea. Patients with orthopnea, instead of lying down, have to adopt a semi-sitting position, for example by using several pillows.

An extremely pronounced manifestation of heart failure is pulmonary edema. With pulmonary edema, a feeling of suffocation occurs, severe dyspnea with a respiratory rate of more than 30 per minute, sweating is observed. Patients cannot lie down and take a sitting or standing position (orthopnea), leaning on the edge or back of the bed. Wheezing in the lungs is heard at a distance. In advanced cases, bubbling breathing and coughing up pinkish foamy sputum are noted.

Dyspnea in right heart disease (pulmonary embolism and pulmonary heart disease, pulmonary valve stenosis, right ventricular infarction) and cardiac tamponade is, in most cases, not accompanied by orthopnea, since there is no venous congestion in the lungs. Patients can usually be in a supine position. Only tachypnea (increased respiratory rate) and signs of venous congestion in the systemic circulation are noted. This is a very important difference from dyspnea caused by left ventricular failure, since diuretics and vasodilators are contraindicated in right heart disease. And in case of hypotension, intravenous fluid administration is indicated.

The following diseases and pathological conditions lead to the appearance of shortness of breath.

1. Respiratory diseases;
   • chronic obstructive bronchitis:
   • bronchial asthma;
   • irritative bronchial obstruction (inhalation of vapors of acids and alkalis, chlorine, ammonia, hydrogen sulfide, nitrogen oxides and other substances, pollutants, as well as temperature effects on the bronchial mucosa);
   • pneumonia;
   • acute bronchiolitis;
   • pulmonary tuberculosis, sarcoidosis;
   • silicosis;
   • pulmonary edema;
   • oncological lesions of the respiratory organs;
   • non-oncological diseases leading to stenosis of the trachea and larynx (Quincke's edema, viral infection with stenosis of the larynx, diphtheria croup, retropharyngeal abscess, foreign body, etc.);
   • pulmonary atelectasis:
   • pulmonary emphysema;
   • pleurisy with effusion, pleural empyema, pneumothorax, hemothorax:
   • pneumomediastinum;
   • interstitial lung diseases, including rare diseases that can be diagnosed in pediatric practice (familial cystic fibrosis of the lungs, idiopathic pulmonary hemosiderosis, alveolar pulmonary proteinosis), as well as systemic diseases (scleroderma, some variants of Bechterew's disease, rheumatoid arthritis, various pulmonary vasculitides), radiation pulmonary fibrosis;
   • tracheobronchomegaly;
   • cystic fibrosis.
2. Cardiovascular diseases:
   • ischemic heart disease; myocarditis, cardiomyopathy, pericarditis, heart defects;
   • hypertension;
   • dissecting aortic aneurysm; thromboembolism.
3. Blood diseases in which the ability to bind oxygen and transport it to organs and tissues is reduced:
   • anemia of various etiologies;
   • carbon monoxide poisoning;
   • methemoglobinemia.
4. Respiratory muscle damage:
   • poliomyelitis (damages the nerves that innervate the intercostal muscles, diaphragm and other groups of respiratory muscles):
   • myasthenia;
   • dermatomyositis (if the respiratory muscles are involved in the process);
   • nicotine poisoning;
   • hypokalemia;
   • post-diphtheritic paralysis of the respiratory muscles.
5. Dyspnea of central origin (depression of the respiratory center):
   • overdose of anesthetics, barbiturates, morphine;
   • uremia;
   • acidosis;
   • brain tumors;
   • cerebral hemorrhage, cerebral edema;
   • bulbar poliomyelitis; meningitis, encephalitis.
6. Endocrine disorders (thyroid disease, obesity, hypoparathyroidism, hypothalamic pathology, Addison's disease).
7. Psychogenic dyspnea in neuroses, hysteria.
8. Pressure on the diaphragm from the abdominal cavity (ascites, severe flatulence, etc.), kyphoscoliosis, age-related rigidity of the chest.
9. Fevers of various origins.

What else can cause shortness of breath?

In addition, there is also the concept of atypical, transient dyspnea: this type of dyspnea may be associated with the use of certain medications or substances. At the end of treatment, the respiratory rhythm is restored.

• Shortness of breath in acute bronchitis most often signals the possible development of complications in the form of pneumonia or pleurisy, or the transition of the acute process to chronic. Shortness of breath in bronchitis should be distinguished from paroxysmal suffocation - this is a particularly difficult breathing, which is often provoked by blockage of the bronchial lumen with viscous dense sputum, which, in turn, leads to stenosis and even deformation of the bronchial branch. A similar situation is typical for obstructive bronchitis - on an extended exhalation, the patient makes a specific "whistle" that can be heard even from a distance.
• Shortness of breath from allergies appears immediately after the allergen has affected the patient's body. The course of such shortness of breath is paroxysmal, with a different course - from mild to severe and dangerous. Treatment of such shortness of breath may not lead to a positive result if the allergen that caused the reaction is not eliminated.
• Shortness of breath from smoking can happen to both a novice smoker and a person with "experience". The complication is associated with a spasm of the bronchial lumen, which leads to breathing difficulties. In order for such shortness of breath not to lead to the development of bronchial asthma over time, you need to not only look for good remedies for shortness of breath, but also think about quitting the bad habit.
• Shortness of breath from osteochondrosis occurs when the thoracic vertebrae are out of alignment, when nerve fibers and blood vessels are pinched. With such disorders, oxygen deficiency occurs: the body switches on a compensation mode, in which the frequency and depth of breathing changes. The patient feels a lack of air, tries to take a deep breath - at this moment, as a rule, pain appears in the damaged area of the thoracic spine.
• Shortness of breath from nerves is also called respiratory neurosis. The reason for this phenomenon is not always due to frequent stress or anxiety, but the psychological factor plays a major role here.
• Shortness of breath from antibiotics and other medications is a very common phenomenon. Such a reaction is considered a frequent side effect of taking antibiotics, sulfonamides, many cardiotonic and neurological medications. Less often, dyspnea is caused by non-steroidal anti-inflammatory and antihistamine drugs - especially in people prone to drug hypersensitivity. The mechanism of development of this type of shortness of breath is that many medications lead to the accumulation of bronchial secretions, which, against the background of weakness and reduced immunity, provokes difficulty breathing.
• Shortness of breath from Phlebodia is a very rare phenomenon that can only occur in people prone to hypersensitivity. Phlebodia is a diosmin preparation, which is an angioprotective and capillary stabilizing agent. Phlebodia is considered a modern medicine that rarely causes side effects and is well accepted by most patients.
• Shortness of breath from Prednisolone occurs only in isolated cases - more often the opposite happens: Prednisolone is prescribed to eliminate problems with the respiratory system. However, the possibility of developing hypersensitivity cannot be ruled out - such a condition can happen to any patient.
• Shortness of breath from physical exertion is a normal reaction of the body, which has not been previously subjected to training. In particular, shortness of breath often appears in those who previously led a sedentary lifestyle. If you train regularly, then over time, breathing problems during physical exertion will disappear on their own.
• Shortness of breath from coffee can happen because caffeine increases blood pressure and stimulates cardiac activity. However, this side effect does not happen to all coffee lovers - for some people, coffee, on the contrary, can relieve an attack of difficulty breathing. Therefore, you need to listen carefully to your body: if coffee causes any unpleasant symptoms, then it is better to refuse the drink. Some experts believe that only instant coffee can cause shortness of breath, and high-quality brewed coffee does not have such an effect.
• Shortness of breath when quitting smoking often causes concern in people. What is it connected with? In fact, nothing terrible happens: the lungs are simply being cleansed and rebuilt into a new, healthy mode of operation. Dyspnea can continue throughout the entire period of cleansing, which usually lasts about six months. However, to avoid negative consequences, it is better to undergo a respiratory diagnosis.
• Shortness of breath from beer or other alcoholic beverages is not such a rare phenomenon. Even a single use of alcohol can disrupt the heart for several days - myocardial nutrition suffers, the heart rate increases, blood vessels narrow, and blood thickens. As a result, there is oxygen deficiency in the heart, which over time can develop into cardiovascular failure.

Why do I get short of breath with even the slightest exertion?

Heart problems often do not attract attention at first. But for many people, the first "alarm bell" is shortness of breath, even with little physical activity or at rest. Most heart and vascular diseases are manifested by shortness of breath, but you need to listen carefully to your body: are there any other painful symptoms?

• In case of heart failure, shortness of breath with little physical activity is accompanied by a frequent feeling of fatigue and weakness. Additionally, dizziness and periodic tingling in the heart area may bother you.
• In hypertension, dyspnea is associated with excessive strain on the heart due to high blood pressure. The condition may be aggravated by a feeling of fatigue, pain in the back of the head or throughout the head, and ringing in the ears.
• The pre-infarction condition occurs not only with shortness of breath, but also with increased heart rate, cold sweat, and an internal feeling of fear.
• Myocardial ischemia may occur with pronounced signs of nausea and sweating. Dyspnea is combined with a pressing sensation behind the breastbone.
• Heart rhythm disturbances can be different, but they are often accompanied by a feeling of the heart “jumping out”, shortness of breath, severe weakness, and clouding of consciousness.
• Mitral valve prolapse often causes general weakness, dizziness, shortness of breath, and a feeling of fullness in the chest.
• Cardiac asthma is accompanied by severe paroxysmal shortness of breath, cyanosis of the skin, and increased sweating.

If dyspnea is associated with heart problems, then taking the appropriate medication to normalize heart function will certainly lead to a softening and subsequent disappearance of signs of respiratory failure.

What causes shortness of breath when walking?

Shortness of breath that regularly occurs when walking is often associated with problems in the respiratory, cardiac and vascular systems. Breathing deteriorates gradually, the breathing rate slows down, the skin turns pale, and the lips turn blue.

But this condition is not always associated with illness. If a person leads a sedentary lifestyle, does not move enough, spends a lot of time sitting in front of a computer or TV monitor, then his body has simply “unaccustomed” to stress. Even walking can become a kind of “overload” for such a person. “Hypodynamic” dyspnea especially often occurs when accelerating a step, as well as when climbing stairs.

If shortness of breath when walking bothers only in the cold season - and this happens quite often, then such pathological conditions as anemia, slow metabolism, allergic processes may be to blame. In this situation, one can recommend a balanced diet, taking multivitamin preparations, as well as practicing proper breathing to optimize pulmonary ventilation.

Shortness of breath from walking during pregnancy

Dyspnea in pregnant women is more often observed in the second half of pregnancy and usually has a physiological explanation.

Thus, shortness of breath may occur as an adaptation mechanism – after all, the body of a pregnant woman requires more oxygen due to increased blood circulation.

Hormonal changes are also of great importance. For example, progesterone is an extremely important hormone for both conception and maintenance of pregnancy, it activates the respiratory center in the brain, which leads to increased ventilation of the lungs.

The fetus develops and grows, and at the same time the size of the uterus increases, which eventually begins to press on nearby organs. Closer to the third trimester, the uterus begins to press on the diaphragm, which in most cases provokes shortness of breath. Such shortness of breath is characterized by mixed - that is, it is equally difficult to inhale and exhale. By the way, when the uterus descends a little - and this happens approximately ½-1 month before childbirth, breathing becomes easier.

The listed reasons are considered physiological and do not require additional medical intervention. The only recommendations are rest, yoga and breathing exercises, and obesity prevention.

However, one should not discard the possibility of pathology. The following reasons require mandatory consultation with a doctor; they cannot be ignored:

• decreased hemoglobin levels (oxygen transport to tissues is impaired);
• atherosclerosis of blood vessels, as a result of illness or smoking;
• frequent or severe stress;
• respiratory diseases (pneumonia, bronchitis, obstructive bronchitis, asthma);
• heart and vascular diseases (cardiopathy, coronary heart disease, heart defects).

If the breathing problem is accompanied by other painful symptoms (fever, cough, dizziness, headaches, etc.), then in any case it is necessary to consult a doctor.

Why does a child have shortness of breath?

Dyspnea in children often occurs for the same reasons that it occurs in adult patients. However, due to the special hypersensitivity of the children's respiratory system, such factors as fright, physical overload, high temperature, high room temperature, etc. can quite easily influence the occurrence of the problem.

You should not try to determine the cause of the disorder yourself: this should be done by a pediatrician, since such a cause is not always harmless. Difficulty breathing in a child is most often caused by the following conditions:

• allergic reaction;
• runny nose;
• asthma;
• flu, acute respiratory viral infection, adenovirus infection;
• heart or lung disease;
• inhalation of a foreign object (this condition is considered extreme and requires immediate medical attention);
• stressful situations, diseases of the nervous system (the so-called hyperventilation syndrome);
• excess weight;
• genetic pathologies of the respiratory system (for example, cystic fibrosis);
• hormonal and immune disorders.

In children, complications develop much faster than in adults. Therefore, after detecting respiratory problems in a child, it is necessary to seek medical help without delay. The doctor will determine the cause and prescribe the main treatment and the appropriate remedy for shortness of breath.