What is Shortness of Breath and Why is It So Important?
Air hunger, tightness in the chest, feeling of not being able to breathe... Shortness of breath, medically called "dyspnea", is a common complaint that one in every four adults in Turkey experiences at least once in their life. Sometimes it is a simple lack of fitness or a temporary panic attack, and sometimes it can be the first and only sign of life-threatening conditions such as heart attack or lung clot. That's why "What causes shortness of breath?" The answer to the question is very different from person to person and early diagnosis saves lives.
Shortness of breath can occur with exertion (climbing stairs, walking fast) or at rest or even while sleeping. If you are accompanied by symptoms such as waking up in the middle of the night feeling like you can't breathe, not being able to complete sentences while speaking, or bruising on your lips and nails, you should consult a doctor without delay.
In this article, we will discuss the 15 most common causes of shortness of breath, one by one, in an understandable and detailed manner. You will learn which symptoms indicate which disease, what you can do at home, and most importantly, when you should go to the emergency room.
1. Asthma
Asthma is a disease characterized by chronic inflammation and hypersensitivity of the airways. When faced with triggers (allergens, cold weather, exercise, cigarette smoke, stress), the airways narrow, swell and produce dense phlegm. The patient describes it as "I have wheezing in my chest, a whistling sound." Shortness of breath increases especially at night and in the morning. It is estimated that there are approximately 4 million asthma patients in Turkey. If left untreated, attacks become increasingly severe and seriously reduce the quality of life.
2. COPD (Chronic Obstructive Pulmonary Disease)
It most commonly develops as a result of smoking and long-term exposure to smoke. The air sacs (alveoli) in the lungs are destroyed, the airways narrow, and the person constantly feels like "I can't breathe enough." Cough with phlegm and feeling of tightness in the chest in the morning are typical. It becomes difficult to climb stairs and even get dressed. COPD is considered the sixth cause of death and unfortunately it is irreversible; however, its progression can be largely stopped if smoking is stopped.
3. Heart Failure
If the heart cannot contract strong enough, it cannot pump enough blood to the lungs and body. Fluid begins to accumulate in the lungs. The patient experiences shortness of breath, especially when lying down, and has to keep his head slightly elevated (orthopnea). Shortness of breath begins within a few minutes when you get up to go to the toilet at night or lie on your back, and it eases when you sit or stand up. It is accompanied by swelling in the legs, bloating in the abdomen and extreme fatigue.
4. Coronary Artery Disease and Heart Attack Risk
When the heart vessels narrow, the heart's oxygen needs cannot be met. Shortness of breath occurs along with chest pain (angina pectoris). Pain usually begins with exertion and goes away with rest. If the pain lasts longer than 20 minutes, there is sweating, nausea, and pain radiating to the left arm and jaw, this may be a heart attack. Shortness of breath is the most commonly overlooked symptom of a heart attack, especially in women and the elderly.
5. Anemia
With the decrease in red blood cells or hemoglobin, not enough oxygen can be carried to the tissues. The patient suddenly becomes out of breath while climbing stairs or walking fast. It is accompanied by dizziness, weakness, palpitations, pallor, hair loss and collapsed nails. Iron, B12 or folic acid deficiency are among the most common causes. It is easily diagnosed with a blood test, and with treatment, improvement begins within a few weeks.
6. Panic Attacks and Anxiety Disorder
When the brain signals "I am in danger", the body shows a fight-flight response. The heart accelerates, the muscles tense, and the person feels "I can't breathe, I'm suffocating." In fact, the oxygen level is normal or even high, but the brain cannot perceive it. Numbness in hands and feet, fear of death, and dizziness are common. The attack usually lasts 10-20 minutes and passes on its own. Recurrent attacks greatly impair the person's quality of life.
7. Obesity
Excess weight pushes the diaphragm down, making it difficult for the lungs to expand. Intra-abdominal fat makes breathing difficult, especially when lying down. Additionally, obesity increases the risk of sleep apnea by up to 10 times. As you lose weight, shortness of breath decreases significantly; Even 10 kilos of weight loss provides miraculous recovery in most patients.
8. Pulmonary Embolism (Lung Clot)
The clot formed in the leg veins breaks off and travels to the lungs, blocking the vein. Sudden onset, very severe shortness of breath, chest pain (increasing with breathing), coughing up blood, and feeling faint are observed. It is one of the most urgent causes of shortness of breath because the risk of death is very high. Risk groups include long plane journeys, postpartum period, cancer patients and post-surgery patients.
9. Pneumothorax (Lung Collapse)
There is a tear in the lung membrane and the lung collapses and air fills the chest cavity. There is sudden onset, stabbing chest pain and shortness of breath. It may occur spontaneously in young, tall, thin men. The risk increases 20 times in smokers.
10. Severe Allergic Reactions and Anaphylaxis
Bee stings, medicines, and foods such as peanuts can cause a sudden allergic reaction. Lips and tongue swell, throat closes, wheezing and widespread rash occur. It develops within minutes and can be fatal if adrenaline (EpiPen) is not administered.
11. Reflux (Gastroesophageal Reflux Disease)
Stomach acid escapes into the esophagus and even the respiratory tract. It causes shortness of breath, chronic cough, and hoarseness, especially when lying down at night. Many patients receive treatment for years saying "I have asthma", but it is actually reflux. Raising the head of the bed by 15-20 cm, not lying down for 3 hours after eating, and staying away from triggers such as chocolate, spices and mint are of great benefit.
12. Thyroid Diseases
Hyperthyroidism (overactive thyroid gland) increases heart rate, causes palpitations and shortness of breath. The patient describes it as "it's like there's a motor inside me." It is accompanied by tremors in the hands, weight loss, and irritability.
13. Covid-19 and Long Covid
Some of those who have Covid experience shortness of breath, weakness and chest pain that lasts for weeks to months. Even if there is no permanent damage to the lungs, sensitivity may develop in the nervous system and muscles. Most patients recover with breathing exercises and a gradual exercise program.
14. Cigarettes and Passive Smoking
Shortness of breath in smokers is now considered "normal", but it is very dangerous. More than 7000 chemicals enter the lungs with every breath and cause irreversible damage over years. Shortness of breath decreases significantly within 2-3 weeks after quitting smoking, and the risk of heart attack is halved after 1 year.
15. High Altitude and Travel
Oxygen pressure decreases above 3000 meters. Headache, nausea and shortness of breath occur. It is prevented by slow ascent, drinking plenty of water and, if necessary, oxygen support.
In Which Situations Does Shortness of Breath Require Emergency Service?
- Sudden onset and rapidly increasing severity of shortness of breath
- If accompanied by chest pain, sweating, nausea
- If lips, nails or tongue are bruised
- If you cannot speak or form sentences
- If there is a feeling of fainting or confusion
- Attacks that last longer than 5-10 minutes and do not go away
In these cases, call 112 or go to the nearest emergency room.
Things You Can Do at Home to Relieve Shortness of Breath
- Diaphragmatic breathing: Lie on your back, place one hand on your chest and the other on your stomach. Breathe in deeply through your nose for 4 seconds (just let your belly swell), hold for 4 seconds, exhale slowly through your mouth for 6-8 seconds. Do it for 10 minutes a day.
- Pucker breathing: As you exhale, purse your lips as if whistling, letting the air out slowly. This keeps the airways open.
- Leaning forward position while sitting: Rest your arms on your knees or on a table, leave your shoulders relaxed.
- Elevating the head of the bed: It is very effective in nighttime shortness of breath due to heart failure or reflux.
- Humidifying the room: Dry air irritates the airways.
- Quit smoking: This is the most effective thing that can be done for shortness of breath.
What Information Should You Prepare When Going to the Doctor?
- When did shortness of breath begin?
- Does it occur with effort or at rest?
- Does it wake you up at night?
- Is there cough, phlegm, wheezing, chest pain?
- Do you smoke, how many pack-years?
- Are you experiencing weight gain/loss or swelling in your legs recently?
- What are the medications you use and your chronic diseases?
This information allows the physician to reach the correct diagnosis much faster.
Frequently Asked Questions
What causes shortness of breath while sleeping at night? Shortness of breath at night is most often associated with heart failure, asthma, reflux and sleep apnea. It occurs due to fluid accumulation in the lungs or narrowing of the airways while lying down. If you wake up feeling like you can't breathe, be sure to consult a doctor.
What causes shortness of breath when climbing stairs? The most common causes are lack of conditioning, anemia, asthma, COPD and heart diseases. If you feel out of breath after climbing 1 flight of stairs and this has just started, be sure to get a check-up.
How can it be understood whether the shortness of breath is caused by the heart or the lungs? Swelling in the legs, shortness of breath when lying down at night, relief when sitting down, in favor of the heart; Wheezing, cough, phlegm and a history of smoking are considered in favor of lung disease. For a definitive distinction, ECG, chest radiography, exercise test and, if necessary, echocardiography are required.
What causes shortness of breath during pregnancy? Is it normal? Especially in the last 3 months of pregnancy, the growing uterus puts pressure on the diaphragm and prevents the lungs from fully expanding. Additionally, increased blood volume and anemia are common. Mild shortness of breath is considered normal, but if it is sudden and severe, evaluation for preeclampsia or clot is required.
What causes shortness of breath most frequently in children? The most common causes of shortness of breath in children between the ages of 0-6 are croup, foreign body aspiration and asthma attacks. If there is chest collapse, wheezing, rapid breathing and cyanosis, call 112 without delay.
Shortness of breath is a complaint that should never be considered "normal". With early diagnosis and correct treatment, most patients can fully recover. If you or your loved ones have these symptoms, please do not delay, consult a pulmonologist or cardiologist without delay. Breathing is life.
