Difficulty Breathing (Dyspnea)

What dyspnea feels like

People describe difficulty breathing in different ways, and the words they use give doctors clues:

• Air hunger or "can't get a deep enough breath": common in heart failure, lung disease and anxiety
• Chest tightness: typical of asthma
• Increased work of breathing, using shoulder and neck muscles: COPD, severe asthma, muscle weakness
• Breathing too fast (more than about 20 breaths per minute in an adult at rest)

Dyspnea is a symptom, not a disease, and is the same thing as shortness of breath. It means the brain senses a mismatch between how much the body needs to breathe and how well the lungs, heart and muscles are delivering.

Sudden difficulty breathing: emergency causes

When a swollen throat causes difficulty breathing

Throat swelling narrows the upper airway. The signs are a high-pitched sound when breathing in (stridor), a hoarse or muffled voice, drooling and difficulty swallowing. Common causes are anaphylaxis, angioedema (including from ACE inhibitor blood pressure medicines), epiglottitis and throat abscesses. Use an epinephrine auto-injector if prescribed and call 911.

Chronic difficulty breathing: common causes

Lung causes

• Asthma: episodes of wheeze, cough and chest tightness, often triggered by exercise, cold air, allergens or viral infections.
• COPD: slowly worsening breathlessness and daily cough in current or former smokers, usually over 40.
• Interstitial lung disease and pulmonary fibrosis: dry cough and breathlessness on exertion, with crackles heard in the lower lungs.
• Pleural effusion: fluid around the lung from heart failure, infection or cancer.
• Lung cancer: breathlessness with cough, weight loss or coughing blood.

Heart causes

• Heart failure: breathlessness on exertion, then lying flat (orthopnea), waking up gasping at night, swollen ankles and weight gain.
• Heart valve disease: such as aortic stenosis, with breathlessness, chest pain or fainting on exertion.
• Arrhythmias: atrial fibrillation causes breathlessness with a fast, irregular pulse.
• Coronary artery disease: breathlessness can be the equivalent of angina.

Other causes

• Anemia: too few red blood cells to carry oxygen. Fatigue, pale skin and breathlessness on exertion.
• Deconditioning and obesity: the most common reason for breathlessness on exertion in otherwise healthy people.
• Anxiety and panic attacks: fast breathing, tingling hands and lips, chest tightness and a sense of doom. These are diagnosed only after physical causes are considered.
• Pregnancy: mild breathlessness is normal from the first trimester as hormones increase breathing drive. Sudden or severe breathlessness is not.
• Neuromuscular diseases: ALS, myasthenia gravis and Guillain-Barré syndrome weaken the breathing muscles.
• Acid reflux can trigger cough and wheeze.
• Thyroid disease and kidney disease.

Clues from timing and position

How doctors diagnose difficulty breathing

A doctor will ask how quickly it began, what you were doing, whether it occurs at rest, lying flat or with exercise, and about cough, fever, chest pain, leg swelling, smoking, work exposures and medicines. They will measure your breathing rate, pulse, blood pressure and oxygen saturation, and listen to your heart and lungs.

Common tests:

• Pulse oximetry: a clip on the finger measures oxygen saturation. Normal is usually 95% or higher at sea level. Readings can be less accurate on darker skin.
• Chest X-ray: pneumonia, fluid, collapsed lung, heart enlargement.
• ECG and heart blood tests (troponin, BNP).
• Blood count for anemia and infection.
• D-dimer and CT pulmonary angiogram if a blood clot is suspected.
• Spirometry and lung function tests: asthma, COPD and lung scarring.
• Echocardiogram: heart pumping and valves.
• Exercise testing when the cause is still unclear.

Treatment for difficulty breathing

Treatment targets the cause:

• Asthma and COPD: rescue and preventer inhalers, steroids for flares, pulmonary rehabilitation for COPD.
• Anaphylaxis: epinephrine immediately.
• Pneumonia: antibiotics for bacterial pneumonia.
• Heart failure: diuretics to remove excess fluid plus long-term heart medicines.
• Pulmonary embolism: blood thinners.
• Pneumothorax: observation, needle drainage or a chest tube.
• Anemia: iron or treating the cause of blood loss.
• Oxygen: given when oxygen levels are low. It does not help breathlessness when levels are normal.

Things that help you breathe easier

• Positioning: sit upright and lean forward with forearms resting on your knees or a table.
• Pursed-lip breathing: breathe in through the nose for 2 counts, out slowly through pursed lips for 4. This slows breathing and helps empty the lungs in COPD.
• A handheld fan blowing cool air on the face reduces the sensation of breathlessness.
• Pace activities and break tasks into smaller steps.
• Stop smoking and avoid smoke and air pollution.
• Stay active within your limits. Regular exercise improves breathlessness from almost any cause.
• Keep vaccines up to date: flu, COVID-19, pneumococcal and, for older adults, RSV.

Frequently asked questions

What is the difference between dyspnea and shortness of breath?

They mean the same thing. Dyspnea is the medical term for the uncomfortable sensation of difficult or labored breathing. Doctors also use orthopnea for breathlessness lying flat and paroxysmal nocturnal dyspnea for waking at night gasping for breath.

When is difficulty breathing an emergency?

Call 911 if breathlessness starts suddenly or is severe, you cannot speak in full sentences, your lips turn blue or gray, you are confused, or you have chest pain, a swollen throat or tongue, or hives. In children, sucking in of the ribs, grunting or pauses in breathing are emergencies.

Can a swollen throat cause difficulty breathing?

Yes. Swelling of the throat, tongue or voice box narrows the airway. Allergic reactions, angioedema, epiglottitis and throat abscesses can all do this. Warning signs are noisy breathing, a muffled or hoarse voice and drooling. It needs emergency care, and epinephrine if anaphylaxis is suspected.

Why do I get short of breath when lying down?

Breathlessness lying flat is called orthopnea. It is a classic sign of heart failure, as fluid shifts into the lungs. Obesity, a large pleural effusion, severe COPD and weakness of the diaphragm can also cause it. Tell your doctor promptly, especially if your ankles are swollen.

Can anxiety cause difficulty breathing?

Yes. Anxiety and panic attacks cause fast breathing, a feeling of not getting enough air, chest tightness and tingling. Symptoms usually peak within 10 minutes. Because heart and lung problems can feel similar, new or severe breathing difficulty should be checked before it is attributed to anxiety.

What is a normal oxygen level?

In healthy adults at sea level, oxygen saturation on a pulse oximeter is usually 95% to 100%. Many people with chronic lung disease run lower, often 88% to 92%, as agreed with their doctor. A reading below 92% with new breathlessness needs medical advice promptly.