Occasional Shortness Of Breath

DEAR DOCTOR K:

Symptoms include shortness of breath, pale skin color and fatigue. An article published in the October 2000 'American Family Physician' states that chronic disease is the most common cause of anemia in the elderly 3. The list includes infections, kidney and liver disease, inflammatory disorders or cancer.

1. When these symptoms occur along with unusual shortness of breath, you should contact your doctor promptly. They raise the likelihood you may be having a serious, even life-threatening, problem: a heart attack, heart failure, pneumonia, a blood clot in the lungs (pulmonary embolism) or an asthma attack.
2. This condition is considered a medical emergency. Urgent care may be required. A pulmonary embolism is a blood clot that occurs in the lungs. It can damage part of the lung and other organs.

I sometimes get short of breath. Should I worry that it’s serious?

DEAR READER:

Shortness of breath is often no big deal. It’s normal to be short of breath for a little while after strenuous exercise or at high altitudes. Some people breathe hard when they’re anxious. When should you worry that shortness of breath might indicate a serious heart or lung condition?

I tell my patients that they know their own bodies a lot better than I do. Their bodies are sending their brains signals every minute. If they think they are getting short of breath in situations that never made them short of breath before, that’s a red flag.

Maybe they have to stop to catch their breath after climbing one flight of stairs, and that never used to happen. Maybe they sometimes feel winded even when they’ve just been sitting, and that never used to happen. Maybe they suddenly feel short of breath for no apparent reason. The key question to ask yourself: Is this new for you? If so, talk to your doctor. There still may not be a serious underlying problem, but you need to be sure of that.

The other really important question to ask yourself when you become unusually short of breath is whether you are also experiencing other worrisome symptoms:

• Chest pain or discomfort
• Swollen ankles and feet
• Fever
• Unusual fatigue
• Painful cough with blood or yellow, green or reddish mucus
• Wheezing and coughing

When these symptoms occur along with unusual shortness of breath, you should contact your doctor promptly. They raise the likelihood you may be having a serious, even life-threatening, problem: a heart attack, heart failure, pneumonia, a blood clot in the lungs (pulmonary embolism) or an asthma attack.

Before you call your doctor for shortness of breath, be prepared to answer the following questions. They will help your doctor assess the urgency of your situation. If your doctor doesn’t ask these questions, volunteer the information:

1. Is there chest pain, and what does it feel like? Is it a sharp and stabbing pain? Or does it feel more like a dull pressure? Does it travel anywhere (like into your neck, jaw, shoulder, arm or back)?
2. Are you sweating profusely?
3. Do you have trouble breathing when you lie down?
4. Are your legs or ankles swollen?
5. Do you have a cough or fever?
6. How fast are you breathing?

You don’t want to get terrified every time you have a potentially serious symptom. But you also don’t want to miss an early signal that something serious may be wrong. You need to know when, and when not, to worry.

Dyspnea or shortness of breath is when you try to catch your breath and it becomes difficult to inhale and exhale. Intermittent shortness of breath is the shortness of breath that comes and goes, sometimes triggered by an external factor and sometimes just on its own. It can be because of a physical blockage in the airway starting from the nose to the lungs, or spasm of the trachea causing it to constrict. It can even be because of fluid build up in the pleural cavity – area between the lungs and the covering of the lungs which is called pleura.

It is vital to ask certain questions to establish whether the cause of shortness of breath has a respiratory origin, a cardiovascular origin or some other underlying disease.

Important Questions To Ask Yourself

1. Is your shortness of breath seasonal, allergic or work related? Does it occur at a particular time of the day or at a particular place?

2. Do you experience shortness of breath when walking, during a strenuous activity or at rest?

3. What causes worsening of your shortness of breath? Maybe some physical activity or a mental stress or even lying down flat?

4. What brings relief to your shortness of breath? Any medication, deep breathing etc?

5. What other symptoms are associated with it?

• Cough; dry or productive (with phlegm)
• Fever: low grade or high
• Cyanosis or bluish discoloration of lips, skin or nails
• Pitting edema/swelling in the feet or sacrum
• Wheezing: whistling sound during breathing
• Nasal congestion (nose block) or postnasal drip
• Chest pain; sudden or gradual onset
• Disorientation or loss of consciousness (even for little period of time)

6. Do you suffer from diabetes, heart, kidney or liver disease, deep venous thrombosis and/or anxiety and depression?

7. Are you anemic, obese, pregnant or underwent a major surgery?

If you can answer the above questions, you will at least be able to tell whether your shortness of breath that comes and goes is due to a lung disease or some other organ disorder. Insufficiency in various systems of the body can cause shortness of breath that comes and goes.

Respiratory Causes of Intermittent Shortness Of Breath

The cause of shortness of breath that comes and goes is usually attributed to the lungs if it is accompanied by the worsening of cough with clear, yellow, light brown, or green mucus or blood, stuffy nose and sore throat or wheezing.

Following diseases should be investigated, most of which can be diagnosed through chest x-Ray and complete blood count (CBC).

1. Chronic Obstructive Pulmonary Disease (COPD)

These diseases cause obstruction in airway either by mucous congestion, spasm or damage to alveoli.

• Asthma: allergic or non allergic constriction (spasm) of trachea along with accumulation of mucous in airways usually accompanied by wheezing.
• Emphysema: destruction and expansion of air spaces
• Bronchitis: inflammation in the lower pulmonary tract i.e. the alveoli
• Bronchiectasis: permanent dilatation of alveoli

2. Restrictive Lung Disease

These are conditions in which lung expansion is restricted either due to fibrosis or pressure on the outside in the form of fluid or blood.

• Pneumoconiosis: deposition of substances like coal, asbestos and silicone in the lung causing restricted expansion
• Pneumothorax: collapsed lung
• Hemothorax: blood surrounding the lungs
• Pleural Effusion: fluid surrounding the lungs

3. Lung Circulation

• Pulmonary embolism: blockage of a pulmonary artery due to a blood clot
• Pulmonary hypertension: high blood pressure in the arteries of the lungs
• Pregnancy

4. Pulmonary Edema

This usually occurs secondarily to other diseases causing fluid overload and can be found in:

• Congestive Heart Failure: causing backup fluid overload in the lungs
• Kidney Failure: due to decreased ability to excrete excess fluid
• Chronic Liver Disease: due to decreases protein production in body causing weakens vessels that leak fluid
• At high altitudes: may result in hyperventilation

5. Other Lung Related Causes

• Hyperventilation Syndrome: This is an anxiety related dyspnea that occurs because of fast breathing that lowers CO2 in blood to the extent that one feels dizzy and suffocated. It is often seen in patients with panic disorders and is precipitated by emotionally stressful events. Home remedy includes breathing in a bag (not more than 6-8 breaths at a time) that helps building up CO2 in the body making you feel better. Remove the bag from nose and mouth after 6-8 breaths and breathe normally for a few minutes and then repeat again till you stop hyperventilating.
• Pneumonia: Bacterial infection of the lungs mostly associated with high grade fever and muco-purulent sputum
• Tuberculosis
• Lung cancer: primary or metastatic

Cardiovascular Causes Of Shortness Of Breath That Comes And Goes

Heart Conditions That Cause Short Of Breath

If the shortness of breath occurs during activity, it could be due to a heart condition in which enough blood is not getting pumped out. If it occurs at rest, or while you’re lying flat, congestive heart failure is more likely the cause. Other signs of congestive heart failure include constant dry coughing and pitting edema of the lower legs. Women usually do not have typical symptoms of angina.

Most heart disorders can be diagnosed through ECG and echocardiogram. These can detect:

• Arrhythmia: irregular heart beat
• Cardiogenic shock: ineffective heart function
• Cardiomyopathy: weakened or abnormal heart muscle function
• Cardiovascular disease due to hardening of the arteries (atherosclerosis)
• Congenital heart defects: valvular and septal defects
• Congestive heart failure: deterioration of the heart’s ability to pump blood
• Myocardial infarction: heart attack

Other Causes Of Intermittent Shortness Of Breath

Shortness of breath can also have other causes including:

• Anemia: resulting in fatigue and shortness of breath when walking
• Anaphylaxis: severe allergic reaction
• Dehydration: loss of body fluids and electrolytes, which can be life threatening when severe and untreated
• Diabetic ketoacidosis: life-threatening complication of diabetes with blood sugar rising more than 300 mg/dl (normal is under 120 mg/dl)
• Electrolyte imbalance
• Kidney or liver failure
• Obesity
• Sepsis: life-threatening bacterial infection of blood

Life Threatening Symptoms Not To Ignore

Occasional Shortness Of Breath When Walking

In some cases, shortness of breath may be a symptom of a life-threatening condition that should be immediately evaluated in an emergency setting. If you experience any of the following symptoms along with shortness of breath, you should seek medical attention as early as you can.

Occasional Shortness Of Breath Causes

• High grade fever, higher than 101 F, that never touches baseline: indicative of pneumonia
• Bluish coloration of the lips, fingernails or skin (cyanosis): risk of heart failure
• Chest pain, tightness or pressure: probably a heart attack
• Confusion or loss of consciousness even for a brief moment: suggestive of lung compromise
• Heart palpitations
• Sudden swelling of the face, lips or tongue: anaphylactic reaction
• Hemoptysis: coughing up blood suggestive of TB or lung cancer

What To Do If You Are Suffering From Intermittent Shortness Of Breath

People may not take shortness of breath that comes and goes seriously since it is not there all the time. It may confuse women who are pregnant or those having a heart attack since these are not normally found in angina patients. Shortness of breath when walking is taken lightly too, as part of fatigue and a lot of people do not associate anxiety and shortness of breath together, as a part of a bigger underlying problem, which needs to be addressed. Intermittent shortness of breath or dyspnea is not a disease on its own, but a symptom pointing to many things that could be going wrong inside of the body. That is why it is important to get yourself evaluated thoroughly by a doctor, who might run some very basic tests, to determine whether the underlying cause is serious or not.

Investigative Work Up

The basic tests your doctor might prescribe include:

1. Complete blood count ( CBC ): This can diagnose anemia and any chronic inflammation or life threatening infection that you may have acquired.
2. Chest X Ray: Diagnostic for most lung disorders and even show enlargement of heart
3. Pulse oximetry and spirometry: For lung function
4. ECG and Stress Tests: To determine underlying heart disease
5. Sputum Culture and Sensitivity Test: In case you are producing a lot of mucous during cough. This can detect blood, bacteria and TB organism in sputum.
6. Liver Function Tests (LFTs) and Renal Profile for kidney function can tell if these are responsible for the shortness of breath that comes and goes.

Treatment

1. Short acting or long acting bronchodilators depending on the severity of dyspnea.
2. Nasal decongestants, cough suppressants, anti-histamine (anti-allergy) for symptomatic treatment.
3. Steroids for life threatening inflammatory condition.
4. Diuretics in case you have fluid over load as in case of heart failure, liver failure, kidney failure, pulmonary edema or pleural effusion.
5. Invasive procedures for the lung and heart might be necessary to treat underlying disease.

When the underlying cause of intermittent shortness of breath cannot be established definitively or when symptoms are disproportionate to the apparent severity of the disease, a consultation with a specialist is indicated. Referral also is required when a specific diagnostic procedure is needed to establish a diagnosis (e.g., lung biopsy or cardiac catheterization). Finally, patients who do not respond to therapy will also need consultation with specialists to confirm the diagnosis or maximize therapy.