What is shortness of breath, dyspnoea or difficulty breathing? What causes it?

What is shortness of breath, dyspnoea or difficulty breathing? What causes it?
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Shortness of breath is characterized by a feeling of not getting enough air. Shortness of breath is often described by a feeling of choking or not getting enough breath. It is a symptom of various health problems and diseases.

Shortness of breath (also known as dyspnoea) is a subjective symptom of difficulty breathing. People often describe it as feeling short of breath, sometimes with a feeling of heaviness or pressure in the chest.

Shortness of breath = dyspnoea - from the Greek dyspnoia and Latin dyspnoea.

Labored breathing can also be described as breathlessness in which the current need for momentary physical activity cannot be met.

In the elderly it may accompany cardiovascular disease, in the young it may be due to psychological causes or some serious disease of the lung tissue, and in children it may be caused by injury.

Shortness of breath is a symptom of a large number of diseases and indicates a deterioration in health. It is primarily a subjective feeling, i.e. a feeling perceived by the person affected.

Shortness of breath can therefore be a purely subjective feeling and does not necessarily indicate breathing insufficiency. It often occurs with psychological strain or stress and also with spinal problems.

On the other hand, severe respiratory disturbances in which the representation of blood gases (change in partial pressures) also changes. Such a condition is followed by objective changes and breathing disturbances. Examples include the frequency or depth of breathing as well as cyanosis (blue discoloration of the skin).

In severe cases, orthopnoea is a serious manifestation. This means resting dyspnoea. The person is immobile, with his hands on the mat, which helps him to engage the accessory respiratory muscles. The condition worsens with little exertion or speech, and the person is unable to lie down.

The frequency is either accelerated or, on the contrary, slowed down. Breaths are deepened or, on the contrary, shallow. Pathological breathing phenomena such as wheezing, hoarseness, gurgling and others may be audible at a distance.

In addition, other symptoms such as swelling of the limbs or body, heart palpitations, chest pain, sweating, fatigue, pallor, nausea, or an increase in body temperature or even fever may be associated with the breathing difficulty.

Shortness of breath is quite common in pregnancy and does not necessarily indicate a health problem. Another example is shortness of breath that occurs after eating. This happens mainly when we have eaten too much food or when we have eaten food that is too heavy on the stomach and gallbladder.

A separate group is shortness of breath as a subjectively impaired perception of breathing in pain. Any pain can induce or even aggravate this unpleasant sensation.

It is important, of course, to monitor the other symptoms.

Dyspnoea can be a manifestation of a variety of health problems and diseases.
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Feeling short of breath or shortness of breath and the most common causes

The respiratory (breathing) system is used to transport air. More specifically, the body needs oxygen and must get rid of excess carbon dioxide.

In addition, breathing is important for maintaining and regulating pH.

Read more about pH in the article.

Respiration itself is composed of 4 phases:

  1. Ventilation - the exchange of gases between the lungs and the environment.
  2. external respiration - the exchange of gases between the alveoli and the blood
  3. transport - transport of O2 to cells and tissues and removal ofCO2
  4. internal respiration - exchange of gases between cells and blood

Air passes through the nose and mouth through the upper airways to the lower airways and lungs. Gas exchange occurs in the alveoli (tiny lung chambers).

The blood in the blood vessels is driven by the heart. The brain and spinal cord control breathing.

And the problem that causes shortness of breath can occur in any of the named parts and levels.

It can be due to inadequate oxygen supply to the tissues, disease of the brain and irritation of the breathing center in the medulla oblongata or lack of oxygen in the environment.

Concepts that are significant in respiration:

  • eupnoea - normal breathing
  • apnoea - cessation of breathing
  • asphyxia - choking, inadequate breathing
  • tachypnea - increased frequency of breathing, regardless of depth
  • bradypnea - slowed breathing
  • hyperpnoea - deepened breathing
  • hypopnoea - shallow breathing
  • hyperventilation - an increase in oxygen delivery above the level of the current need, may indicate deepened or accelerated breathing, or both at the same time
  • dyspnoea - a feeling of difficulty breathing
  • anoxia - absence of oxygen
  • hypoxia - reduced oxygen
  • hypoxaemia - reduced amount of oxygen in the blood
  • hypercapnia - excess carbon dioxide
  • ischemia - insufficient blood supply to tissues and cells
  • acute respiratory insufficiency - a sudden onset condition with a risk to health and life

Dyspnoea is classified according to several characteristics, as shown in the table

Name Description and examples
Exertional After exertion, may initially begin with high exertion, but in more severe conditions, even after little, minimal exertion or speech, the person is unable to speak for breathlessness or longer
Resting occurs even at rest, without a physical or psychological factor
Inspirational the problem is during inspiration, examples are pneumonia - pneumonia, laryngitis, epiglottitis, aspiration (inhalation) of a foreign body, allergy and swelling of the airways
Expiratory the problem is during exhalation, this condition arises in asthma, acute bronchitis
Mixed problem during inspiration and expiration - bronchopneumonia - inflammation of the bronchi and lungs
Rate of progression/onset
  1. Sudden, minutes - for aspiration, pulmonary oedema, pneumothorax, pulmonary embolism, heart attack or trauma
  2. acute, hours - for pneumonia, asthma, heart failure
  3. subacute, days - for sarcoidosis, pleural effusion, cancer, chronic heart failure
  4. chronic, months - for chronic obstructive pulmonary disease, pulmonary fibrosis, chronic heart failure
  5. paroxysmal, paroxysmal, intermittent - as in asthma

In professional practice, there is an NYHA classification that evaluates and categorizes shortness of breath in people with heart disease. It can be used for other problems as well, but is preferably intended for cardiovascular disease.

The table shows the NYHA classification

NYHA classification of dyspnoea NYHA - New York Heart Association
NYHA I Physical activity does not cause shortness of breath or fatigue A person with heart disease but without limitations in daily life
NYHA II no symptoms at rest, light physical activity does not cause fatigue or shortness of breath mild limitation of activities of daily living
NYHA III light physical activity causes fatigue and shortness of breath significant limitation of physical activity
NYHA IV shortness of breath and fatigue occur even at rest, resting dyspnoea person is unable to do any physical activity without difficulty

Shortness of breath is typical for diseases of the respiratory system and lungs as well as for diseases of the cardiovascular system. The cause can be common and minor stressful situations, psychological stress and allergies up to serious and life-threatening conditions.

A coarser division according to the cause hiding inside the chest or outside the chest is also given. In this case, it is further differentiated.

  1. intrathoracic cause - inside the chest
  2. extrathoracic cause - outside the chest
    • O2 transport disorder - anaemia, intoxication, CO andCO2 poisoning
    • metabolic acidosis - in metabolic diseases, diabetes and others
    • central nervous system, brain and medulla oblongata - stroke, tumour, encephalitis (inflammation), trauma
    • neuromuscular diseases - amyotrophic lateral sclerosis, Guillain-Barré syndrome and others
    • non-organic cause - neurosis, fear, stress, psychogenic hyperventilation

The most common causes of breathlessness are listed in the table below

Group Causes
Airway and lung involvement
  • Obstruction of the airways by a foreign body, vomit, food, toys, candy in children
  • obstruction due to swelling, burn, infection, allergic reaction and pinch, hereditary angioedema
  • upper respiratory tract inflammation, dangerous laryngitis in children, epiglottitis
  • obstructive lung disease - chronic obstructive pulmonary disease
  • chronic bronchitis, lower respiratory tract inflammation
  • asthma bronchiale (bronchial asthma) - inflammatory disorder of the bronchi, paroxysmal narrowing accompanied by mucus production
  • bronchiectasis - morbid and irreversible enlargement of the bronchi with inflammation
  • pulmonary emphysema - morbid and permanent enlargement, emphysema of the lung chambers
  • fibrosis of lung tissue - morbid changes in lung tissue
  • lung and chest injuries
  • fluid/water in the lungs
  • seizure disorder with spasm of respiratory muscles, epilepsy is an example
  • lung cancer
  • pulmonary tuberculosis
  • covid-19
Read also: Chronic bronchitis and smoking closely related
Cardiovascular disease
Haematological cause
  • Anemia
Disorders of the central nervous system
External causes
  • Lack of oxygen in the environment and in the inhaled air
  • cellars, wine cellars, fermentation rooms, tunnels, ducts, smoky rooms
  • changes in atmospheric pressure due to altitude or diving to great depths
Use of oxygen in the body
  • CO andCO2 poisoning
  • Cyanide poisoning
Sleep apnoea syndrome
  • Obstructive sleep apnoea - collapse and closure of the upper airway, 80% of cases
  • central sleep apnoea - due to disturbances in the breathing centre during sleep, approximately 10%
  • mixed - both, about 10% of cases

Typical of pulmonary diseases and diseases of the respiratory system

Shortness of breath is, of course, typical of diseases of the respiratory system as listed in the table. There may be more than one.

Seasonal influenza is also an example. Dyspnoea is also common for an increase in body temperature and for fever. It may not rise only in respiratory tract infection.

In airway obstruction, wheezing, which is professionally referred to as stridor, is also present.

Inspiratory stridor = wheezing on inspiration, occurs when there is an obstruction, i.e. an obstruction in the larynx. This happens when a foreign body is aspirated, but also when the larynx is inflamed and swollen.

Expiratory stridor = whistling on exhalation, and this is when there is a problem in the bronchial tubes. An example is asthma.

Stridor can also be mixed if it occurs on both inhalation and exhalation.

Not only in infectious, but also in various inflammatory diseases, excess mucus is formed. This can produce sounds in the form of grunting - typical of congestion. In the elderly, a coughing problem may be present and mucus accumulates in the airways. Shortness of breath is also a result.

These diseases can be of viral, bacterial and yeast origin. A cough is associated, which can be moist with expectoration of mucus or dry, irritating.

What to do if swallowing problems are also present

With inflammatory and infectious disease in the mouth and throat area, swallowing problems may also be associated.

It is typical for tonsillitis. The cause can also be a more serious disease.

Cancer of the larynx also occurs in the young. The risk is not only smoking, but also HPV infection and frequent change of sexual partners. This problem can apply to any cancer in the mouth, throat and neck (thyroid cancer and others).

Difficult breathing and acute deterioration of health

Acute and sudden deterioration in breathing requires the utmost attention. It can also be a serious health and life-threatening condition.

Examples include the aforementioned pulmonary embolism, heart failure or heart attack. However, rapid progression is not limited to cardiac causes.

An allergic reaction, anaphylaxis to anaphylactic shock, can also be serious. And rapid onset can also occur in chest injuries.

Shortness of breath in children

In young children, sudden and acute upper respiratory tract infection also takes place in the form of laryngitis or epiglottitis.

The cause is mainly due to the anatomical arrangement at this age. Even a relatively small swelling or a foreign body when inhaled can create an obstruction (obstacle) to breathing.

Young children put everything in their mouths to find out the properties of the object. Small toys are especially at risk of inhalation. In older children, carelessness when sucking on sweets is also a risk.

Seniors and breathlessness

Older people in particular have food aspiration. Because of their age (and the quality of their teeth), it is harder for them to chew harder foods. Examples include choking on rolls, sausages, citrus fruits and other foods.

In older people, various diseases are associated with smoking, especially chronic bronchitis and chronic obstructive pulmonary disease.

Cardiac sufferers, i.e. people with heart disease, have problems with movement and physical activity. Even a little exertion causes shortness of breath. A senior citizen cannot walk a long distance, he or she becomes short of breath when walking or talking for a long time.

In severe cases, resting dyspnoea is present.

+ Shortness of breath on falling asleep...

Dyspnoea occurs mainly in the supine position. One sleeps in a semi-sitting position, i.e. in an elevated position of the chest and head, even sitting up.

The cause is insufficient cardiac activity, coronary artery disease and heart failure.

Shortness of breath, palpitations and chest pain

Cardiovascular diseases that are related to arrhythmias are also examples. In this case, breathing difficulty is also associated with palpitations. People describe feeling their heart beating fast or slow, skipping a beat, feeling as if their heart has stopped, and so on.

Chest pain with shortness of breath is encountered in coronary causes. It is therefore a problem with the blood vessels of the heart and a problem with insufficient blood supply to the heart muscle, which can lead to a heart attack. Are you familiar with the term angina pectoris?

Shortness of breath from the spine?

With cervical and thoracic spine pain, the pain can shoot between the shoulder blades, to the front of the chest.

People are often afraid of a cardiac cause.

However, the symptoms are often linked to movement and worsening of the difficulty is noted even with a change in position.

You ask:
Why do I find it hard to breathe and my back hurts?

The cause may be a functional impairment of the spine. This causes discomfort but is not severe. On the other hand, there may be an organic impairment of the intervertebral disc or others.

Any chest discomfort associated with difficulty in breathing should not be neglected and should be investigated.

Read also:
Vertebrogenic algic syndrome
Back pain, neck pain, between the shoulder blades, lower back pain + Other problems
How to avoid back pain
What is the cause of pain shooting between the shoulder blades?
Spinal stenosis

What does shortness of breath in pregnancy mean, does it need to be treated?

Shortness of breath during pregnancy is quite common. Hormonal changes are also a problem. The main cause is directly related to the growth of the fetus and therefore the uterus. The abdominal ratios change, the diaphragm is more oppressed.

This causes shortness of breath.

It is most pronounced in the third trimester. The situation begins to improve somewhat around the 36th week. The fetus and uterus prepare for birth and drop lower.

Women should slow down more towards the end of pregnancy, not over-exert themselves with strenuous physical activities and save energy with slower movements.

In pregnancy, it is common to swell the lower limbs. However, in this case and when shortness of breath occurs, it is necessary to monitor the state of health and associated symptoms.

Dyspnoea is accentuated in anaemia. A more severe condition arises in pre-eclampsia and eclampsia.

Read more in the articles:
How to recognize pre-eclampsia and its symptoms in pregnancy?
Beware of anaemia inpregnancy. What are its causes, symptoms?
Proteinin urine during pregnancy? It may or may not be a problem

When any health problems occur during pregnancy, a professional examination is necessary.

What could be behind the heavy breathing?

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