Shortness of breath

Feeling breathless — a tightness in the chest or having trouble getting enough air — is called dyspnea. Although it’s common as you age, having trouble breathing shouldn’t be dismissed as just part of getting older. Shortness of breath isn’t a disease itself, but a symptom of other health conditions.

How your heart and lungs function contribute to shortness of breath. Both organs work together to move oxygen and remove carbon dioxide all throughout your body. If either one can’t keep up, the level of oxygen in your blood drops. You feel like you have to work harder to breathe.

You may have brief shortness of breath during intense exercise, in extreme temperatures, at high altitudes or while congested. However, dyspnea that lasts several weeks or keeps coming back could be a sign of a medical condition.

Common causes of breathlessness

Shortness of breath is often linked to:

• Heart conditions such as angina, heart failure and atrial fibrillation.

• Lung conditions such as chronic obstructive pulmonary disease (COPD), bronchitis, asthma, pneumonia, and pulmonary embolism, where blood clots block blood flow and oxygen exchange inside the lungs.

• Anemia, which is a low level of red blood cells that carry oxygen.

• Mental health conditions such as anxiety, depression and panic attacks.

• Obesity.

• Lack of fitness.

It’s common for a combination of causes to result in shortness of breath. For example, breathlessness can make it difficult to keep up with your exercise routine. But reduced physical activity can lead to weakness and an increased need for oxygen to power the same level of activity.

Shortness of breath can affect your quality of life. Severe breathlessness can make everyday activities such as getting dressed, maintaining your home or going out more difficult. It can even interrupt your sleep.

What to do for shortness of breath

When breathing is hard, you may not be exhaling enough carbon dioxide. In the moment, you might find you need to stop what you’re doing, sit down and focus on your breathing.

See your healthcare team if you have trouble breathing when you’re at rest or if breathlessness becomes much worse. For example, if you’re suddenly breathless from carrying in groceries or walking to the mailbox, make an appointment with your care team.

Seek emergency care if sudden shortness of breath is paired with nausea or chest pain. This may be a symptom of a life-threatening medical emergency.

Diagnostic tests for dyspnea

Your care team may check your lungs with imaging such as an X-ray or a CT scan. Blood tests can check for anemia or other illnesses.  

Other tests can check the function of your lungs:

• Spirometry — helps diagnose asthma and COPD using a tube attached to a machine (spirometer) that measures how much air you can breathe in and out.

• Cardiopulmonary test — measures the amount of oxygen you inhale and the amount of carbon dioxide you exhale while using a treadmill or stationary bike.

Treating and managing shortness of breath

Treating the underlying cause can reduce breathlessness. Make sure to take all prescribed medications for lung or heart conditions as directed.

Also try these helpful self-care measures:

• Stop smoking.

• Avoid exposure to pollutants.

• Avoid extreme heat, humidity and cold.

• Exercise regularly.

• Get recommended vaccines.

• Avoid people who are sick. Even chest colds can have cause serious complications if you are already short of breath.

Heart failure and nighttime breathlessness

If you have heart failure, shortness of breath can come on suddenly at night. Since the heart can’t pump as usual, blood backs up. This causes excess fluid in the lungs that could leave you gasping for air when you lie down.

Work with your care team to optimize your heart failure regimen. Propping up your upper body with pillows might help you breathe easier.

Breathing exercises to improve dyspnea

Your healthcare team might suggest exercises that could strengthen your muscles so that you can take deeper breaths. Here are two to try:

• Pursed lip breathing — With your lips closed, breathe in slowly through your nose, then hold for a few seconds. Purse your lips like you’re going to whistle, and then exhale. Repeat for several breaths over a few minutes.

• Long breathing — Inhale slowly and deeply and let your belly expand with air. Then exhale slowly to push all the air out of your lungs. Try to take at least twice as long to exhale as it took to inhale. Repeat for a few minutes.

Try to do each of these exercises 3 to 4 times a day. Aim for about 10 minutes total each day.