breathlessness

Breathlessness, or dyspnea, is the subjective experience of difficult or uncomfortable breathing. It ranges from mild to life-threatening and may occur with exertion, at rest, or when lying flat. It is distinct from normal exertion and from chest pain alone.

Common causes span cardiopulmonary diseases such as heart failure, COPD, asthma, pulmonary embolism, pneumonia, and interstitial lung disease, as well as anemia, obesity, deconditioning, anxiety, or high altitude. Dyspnea can be acute or chronic and may be episodic or progressive.

Symptoms that can accompany dyspnea include chest tightness, wheeze, dizziness, fatigue, and, in severe cases, cyanosis. Specific patterns include orthopnea (shortness when lying flat) and paroxysmal nocturnal dyspnea (waking at night with breathlessness).

Evaluation typically starts with history, physical exam, and pulse oximetry. Tests may include complete blood count, BNP, chest imaging, spirometry, electrocardiography, and echocardiography to distinguish heart from lung causes and determine urgency.

Management targets the underlying cause. Immediate steps include sitting upright and using breathing techniques; supplemental oxygen may be given if low oxygen saturation is present. Treatments may involve bronchodilators, steroids, diuretics, antibiotics, pulmonary rehabilitation, or other disease-specific therapies.

When to seek urgent care: sudden severe breathlessness with chest pain, fainting, confusion, or blue lips; for persistent or worsening dyspnea, obtain medical assessment promptly. Prevention focuses on managing chronic conditions, vaccination, avoiding smoking, and gradual physical activity as tolerated.