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Common Causes of Breathing Difficulty

Breathing difficulty is one of the most common clinical presentations in practice. Do you know that Breathing difficulty, or dyspnea, can arise from various causes, ranging from benign to life-threatening? The most common causes include:

• Heart and lung conditions: These are the leading causes, such as asthma, chronic obstructive pulmonary disease (COPD), pneumonia, heart failure, and pulmonary embolism (blood clot in the lungs).
• Respiratory infections: Colds, flu, bronchitis, and COVID-19 can cause breathing problems, especially if accompanied by fever, cough, or chest discomfort.
• Allergic reactions: Severe allergies (anaphylaxis) can cause sudden airway narrowing and swelling, leading to acute breathing difficulty.
• Physical obstruction: Choking on food or a foreign object can block the airway and cause immediate distress.
• Heart attack: Chest pain, sweating, and shortness of breath may signal a heart attack.
• Anxiety or panic attacks: These can cause rapid, shallow breathing and a sensation of not getting enough air.
• Obesity or lack of fitness: Excess weight or poor physical condition can make breathing more difficult, especially with exertion.
• Other causes: Anaemia, high altitude, exposure to toxins (like carbon monoxide), and lung cancer can also lead to shortness of breath.

Differentiating Causes

To distinguish between causes, we have to consider:

• Onset and duration: Sudden onset suggests emergencies like heart attack, pulmonary embolism, or choking. Gradual onset is more typical of chronic conditions like asthma or COPD.
• Associated symptoms:
  • Chest pain, sweating, nausea: Suggests a heart attack.
  • Wheezing or whistling sound: Common in asthma or allergic reactions.
  • Fever, cough, chills: Indicate infections like pneumonia or bronchitis.
  • Swelling of face/tongue, hives: Points to severe allergic reaction (anaphylaxis).
  • Bluish lips or nails, confusion: A Sign of low oxygen, often seen in severe heart/lung conditions or obstruction.
  • Anxiety, rapid heartbeat, tingling: May indicate a panic attack or anxiety.
• Triggers: Recent exercise, exposure to allergens, or emotional stress can help identify the cause.

Danger Signs

Seek immediate medical attention if you or someone else has:

• Sudden, severe shortness of breath.
• Breathing difficulty that does not improve with rest.
• Chest pain or pressure.
• Bluish colouration of lips, skin, or nails(cyanosis).
• Confusion, drowsiness, or fainting.
• Rapid or irregular heartbeat.
• Sweating with cool, clammy skin.
• Wheezing, stridor (high-pitched sound), or inability to speak.
• Swelling of the face, lips, or tongue.
• Coughing up blood.
• Inability to lie flat due to breathing difficulty.
• Retractions (chest sinking in with each breath), nasal flaring, or grunting (especially in children).
• Associated with high-grade fever

Basic Workup for Diagnosis

• Pulse oximetry / ABG – assess oxygenation and ventilation
• Chest X-ray – look for pneumonia, CHF, pneumothorax
• ECG – rule out cardiac ischemia or arrhythmia
• Blood Tests:
  • CBC – look for anaemia or infection
  • BNP/NTproBNP – heart failure
  • D-dimer – if suspecting PE (follow up with CT pulmonary angiogram if elevated)
• Spirometry – if suspecting asthma/COPD

3. Advanced Tests (as needed)

• CT thorax
• Echocardiogram
• V/Q scan
• Pulmonary function tests
• Bronchoscopy

Citations:

1. https://my.clevelandclinic.org/health/symptoms/16942-dyspnea
2. https://www.healthline.com/health/home-treatments-for-shortness-of-breath
3. https://www.healthline.com/health/what-does-shortness-of-breath-feel-like
4. https://www.webmd.com/lung/copd/shortness-breath-emergency
5. https://www.hopkinsmedicine.org/health/conditions-and-diseases/signs-of-respiratory-distress
6. https://www.medicalnewstoday.com/articles/324429