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Dyspnea - shortness of breath and difficulty breathing
Normal, unimpeded breathing is a matter of course for us, so we don't waste any great thoughts on it in our everyday life. It is precisely this fact that causes shortness of breath or breath (dyspnea) to be perceived by those affected as a very drastic symptom. Something that actually runs automatically suddenly stops working. This inevitably leads to anxious or even panicky feelings. Sufferers speak of the fact that it literally "closes their throats" and that they experience a real fear of death if they can suddenly no longer breathe freely. However, before the actual shortage of air arises, there are often first signs that a serious breathing problem is developing. The art here is only to correctly interpret the signs of the times.
Dyspnea, as the shortness of breath is called in medical terminology, describes the feeling of difficulty breathing. According to the definition of the American Thoracic Society, this feeling can also be described as "subjective experience of breathing difficulties, consisting of qualitatively different sensations of varying intensity". This subjective experience is due to persistent shortness of breath, which cannot meet the body's oxygen needs in the long run. As a result, the values of the blood gases oxygen (CO²) and carbon dioxide (O²) are massively out of balance. The respiratory drive, which is responsible for regulating the two blood gases, responds accordingly with the alarm signal of shortness of breath.
The exact mechanism that leads to the perception of shortness of breath has hardly been researched medically. However, it is assumed that the area of the brain responsible for breathing, the respiratory center, plays a decisive role here. This is not located near the lungs, as some would assume, but in the elongated medulla (medulla oblongata), which in turn is part of the brain stem (truncus cerebri). As a link between the brain and spinal cord, the brain stem fulfills numerous essential tasks in the area of body functions. In addition to breathing, the elongated marrow in particular is also responsible for swallowing, coughing, sneezing and choking or vomiting reflexes. In addition, even the cardiovascular function is based on the extended marrow.
All of these functions are controlled by the reticular formation (formatio reticularis) located in the brainstem. A network of nerve cells that serves as a circuit for brain stem functions. However, the cerebral cortex (cortex cerebri) also has a decisive influence on the functional units mentioned above. A study by the University of Hamburg seems to have found decisive evidence for the development of shortness of breath as a result of disturbed brainstem functions. The responsible scientists found that damage to a certain section of the cerebral cortex, the so-called island cortex (cortex insularis), reduces the feeling of breathlessness. From this it can be concluded that the island bark in the healthy state is related to the development of dyspnea.
There are also numerous influencing factors that promote shortness of breath. The most important include:
- Disease factors,
- psychological factors,
- physiological factors and
- Environmental factors.
Psychological and physiological factors as the main causes
Shortness of breath occurs particularly often in the context of psychological stress. Initially, the stress trigger triggers various mechanisms, some of which are evolutionary, which put the body on alert by calling up the fight or flight mode that was once vital to human survival. In this mode, breathing changes fundamentally. It becomes faster, but also flatter and the bronchi expand. This effect is desired to a certain extent by the body, as it ensures an increased oxygen supply in exceptional stress-related situations.
Stress breathing normally normalizes itself again as soon as the influence of stress ends. So if you suffer from breathlessness in the course of emotional exceptional states (e.g. euphoria, fear of exams) or extraordinary physical exertion (e.g. sporting activities), you should not get even more hectic, but should strive to calm down and relax, as the oppressive The quickest way to regulate breathing again. However, people are exposed to permanent stress, for example through
- chronic revision,
- persistent lack of sleep,
- unsolved mental problems,
- Panic and anxiety disorders or
- social conflicts,
the body remains in a chronic state of alert. In this way it can happen that rapid and flattened breathing manifests itself in an unconsciously trained, changed breathing pattern. Chronic stress patients therefore often breathe very superficially and cramped without being aware of it themselves. Because the body gradually creeps into a state of lack of oxygen when stressful breathing persists.
The situation is similar in overweight patients, although it is more physiological reasons that cause shortness of breath. Because too much excess adipose tissue in the abdominal cavity inevitably pushes the diaphragm and the lungs permanently in the case of severe obesity. This, mostly in combination with a lack of exercise, causes shortness of breath or gasping due to weight even with the slightest effort.
Such physiological factors are relatively harmless if they are due to pregnancy. Especially in the last months of pregnancy, expectant mothers often complain of breathing difficulties up to shortness of breath. The unborn child is almost fully grown during this time, which leads to a lack of space for organs in the mother's abdomen. It can be observed relatively frequently that the abdominal organs push upwards and thus temporarily push in the lungs. At the latest after the birth of the child, breathing should normalize again.
Respiratory diseases and shortness of breath
Psychological and physiological causes that trigger breathlessness can often be dealt with through private measures (e.g. weight reduction or stress reduction). The situation is different when it comes to the causes of dyspnea, which are of a pathological nature. Respiratory diseases, in which shortness of breath often occurs as a leading symptom in the advanced stage of the disease, can be extremely serious in nature and should therefore be urgently examined by a doctor. The disturbed breathing usually occurs regardless of the cause of the disease through one or a combination of the following three mechanisms:
- the airways are blocked,
- the lungs cannot expand adequately due to illness,
- the area for the necessary gas exchange is too small (lack of space).
The range of causing respiratory diseases is very complex. Of course, respiratory infections, such as one, go most frequently
- Inflammation of the bronchi (bronchitis),
- Inflammation of the larynx (laryngitis),
- Pleurisy or pleurisy
- Sore throat (pharyngitis)
with breathing problems. In most cases, breathing remains difficult for a short time, but extreme illnesses can also provoke serious shortness of breath.
The risk of dyspnea in chronic respiratory diseases is even greater. Bronchial asthma in particular is known here. This leads to regular attacks of shortness of breath, for which allergy and intolerance are the main triggers. Another chronic respiratory disease that is closely related to shortness of breath is chronic obstructive pulmonary disease (COPD). It is also known as a smoking disorder because it arises especially after many years of nicotine consumption and is an expression of a respiratory function that has already been severely affected by cigarette smoke.
Damage to the respiratory muscles is also very risky. Damage to the diaphragm, which acts as the main muscle for breathing, is particularly dangerous in this context. Here are some examples of corresponding diaphragmatic diseases:
- Diaphragmatic inflammation,
- Diaphragmatic hernias,
- Diaphragm high or
- Diaphragmatic ruptures.
In addition to the mentioned respiratory diseases, there are also traumatic disease variants and injuries in the area of the respiratory tract, which subsequently lead to dyspnea. Especially connective tissue diseases and damage to the alveoli are characterized by shortness of breath as a key symptom. This is the case for example with emphysema. Again a chronic respiratory complaint, which can occur in the end stage of numerous previous diseases of the lungs and describes an irreversible bloating of the alveoli. Further examples would be:
- Respiratory tumors (e.g. lung tumor),
- Granuloma formation in the connective tissue of the lungs (sarcoidosis),
- increased connective tissue growth in the area of the alveoli (pulmonary fibrosis),
- Accumulation of blood in the pleural space of the lungs (hematothorax),
- Air in the pleural space of the lungs (pneumothorax),
- blocked pulmonary blood vessels (pulmonary embolism).
Shortness of breath in heart and vascular diseases
Since the heart is directly adjacent to the lungs, shortness of breath due to illness is not uncommonly crystallized as an alarming symptom in cardiovascular diseases. If the heart is damaged, its pumping function also suffers, so that the body can only be insufficiently supplied with oxygen-rich blood. The organism first tries to remedy this deficiency independently by increasing the respiratory rate. As a result, those affected breathe faster and less deeply, which is why there is a feeling of shortness of breath in the long term. This mechanism is completely normal during heavy physical exertion such as sports. If, however, shortness of breath occurs even with low exertion, not only lung diseases but also vascular and heart diseases should be considered, for example:
- High blood pressure,
- acute heart attack,
- Heart failure,
- Heart valve defects,
- Inflammation of the heart muscle and pericardium,
- Coronary artery disease or
- Pericardial effusion.
Important: Another risk with such disease courses is that the risk of lung diseases can also increase as a result of a heart disease. Because the limited pump function sometimes leads to extreme blood build-up. The accumulated blood then flows back into the pulmonary circulation, which in the worst case can lead to fluid accumulation in the lung tissue (pulmonary edema). This in turn means that the area for gas exchange within the lungs is reduced and, accordingly, only a little oxygen can be absorbed into the blood.
Other causes of shortness of breath
Other causes of shortness of breath include anemia and hormonal disorders such as thyroid dysfunction. A malfunction of the thyroid gland as a trigger is particularly to be considered if the disease causes goiter formation in the area of the larynx. In addition, the pain symptoms should not be underestimated as the cause. This is particularly important to consider when those affected adopt a pain-relieved posture, such as a crooked upper body posture, or support themselves permanently with their arms. Pain in the chest area, for example due to muscle tension or vertebral blockages, often leads to acute shortness of breath in this way.
In addition to the feeling of shortness of breath, other accompanying complaints may occur as part of dyspnea. These are not infrequently attributable to the lack of oxygen in the body and the patient's feeling of suffocation. Likewise, some symptoms indicate the type of underlying disease, such as coughing or breathing noises. Overall, the accompanying symptoms in the case of shortness of breath include:
- drawing, rattling or whistling breathing sounds (stridor),
- Bluing of the skin due to lack of oxygen (cyanosis),
- slimy to bloody sputum,
- Facial pallor,
- To cough,
- Racing heart,
- inner unrest,
- Loss of performance,
- Sleep disorders,
- Outbreaks of sweat and cold sweat as well
- Chest pain.
Attention! In extreme cases of breathlessness, an emergency doctor should be called immediately, as this could lead to a fatal cessation of breath!
Breathing difficulties are initially determined by the patient himself. However, a visit to the doctor is always advisable in order to be able to rule out serious causes of illness. Within the medical examination, a physical examination is usual, in which the patient is examined for pale or blue-colored areas of the skin (especially on the face and hands) and an unusual sweat flow. The next step is to use special procedures to determine respiratory functionality. The first priority here is listening to the lungs for breathing sounds. If these are present, this most likely indicates an existing lung or respiratory disease. In such cases, pulmonary function tests such as spirometry are part of the standard procedures for the examinations. Patients breathe through a mouthpiece into a tube that then forwards the breaths to a closed container. Special measuring devices then evaluate the volume of breath and lungs based on the amount of air. In addition, breath tests can reveal special efforts during breathing and at the same time provide information about the severity of the breathing disorders.
If there is any suspicion that a lung disease may be responsible, more detailed examinations of the lower respiratory tract are very likely. For this purpose, for example, imaging diagnostic measures are available, such as laryngoscopy, in which abnormalities in the larynx can be found with the help of a larynx mirror, the laryngoscope. Two other possible examination methods are lung mirroring (bronchoscopy) or chest mirroring (thoracoscopy). An endoscope is inserted into the lungs or thorax in order to make possible tissue damage visible. Tissue removal for laboratory assessment of anomalies is also conceivable. In addition to these detailed measures, special blood tests such as blood gas analysis help to confirm suspicions.
If heart disease is suspected, an ultrasound examination of the heart, the so-called echocardiogram (EKG), is usually carried out. Other imaging methods that can be used in the examination are x-rays, computed tomography (CT) or magnetic resonance imaging (MRI).
Therapy for shortness of breath is based on the cause. Sometimes the shortage of air can worsen to a life-threatening condition and requires medical treatment steps immediately. In the acute situation, however, there are a few instructions for action that are to be suggested to both those affected and their relatives:
- Dial emergency call: Before you do anything else, call your emergency doctor if you are short of breath. Only paramedics are equipped with the necessary specialist medical equipment (e.g. breathing tubes for inturbation) and the necessary know-how to stabilize a patient who is struggling for air.
- Keep calm and breathe consciously: Until the emergency doctor arrives, it is important to keep calm and not panic, as this further worsens breathing. It is also important that those suffering from breathlessness concentrate on their breathing in acute cases. Try to inhale and exhale calmly but sufficiently deeply. Relatives or other third parties who are nearby at the time of breathlessness are encouraged to have a calming effect on those affected, for example by speaking calmly and focusing on the breathing process. As a witness, also instruct the person concerned to breathe properly. In the event of hyperventilation, the patient should be briefly breathed into a bag.
- Remove disruptive clothing: If you are short of breath, tight clothing should be removed or at least opened to make breathing easier. This applies especially to jackets, turtlenecks, tight tops, corsets and bras. Affected people should also be freed from restrictive accessories such as necklaces, scarves or ties.
- Take a suitable sitting position: An upright sitting position is also important to facilitate breathing. If possible, the patient should support his arms on a table, as this makes it easier to use the auxiliary breathing muscles.
- Improve oxygenation: Provide enough fresh air to improve the oxygen supply, for example by opening a window or fanning air.
Drug therapy for dyspnea is based on the underlying cause. In the case of inflammation of the respiratory tract, antibiotics are treated as standard, occasionally with corticosteroids. To expand the gas exchange area in the bronchi, doctors prescribe additional bronchodilators (e.g. salbutamol, formoterol, theophylline).
Bronchial asthma also requires the use of anti-inflammatory drugs and the use of asthma sprays. Most of the time, drug treatment has to be lifelong, which is why asthmatics should make sure that they have their spray always at hand when making their initial diagnosis. In the case of shortness of breath due to mucus, mobilization of the lung secretion by inhalation therapy is also important in order to promote expectoration and thus clear the lungs. If necessary, expectorant preparations can also help.
With cardiac causes of the disease, medication that strengthens the heart or lowers blood pressure can help to relieve shortness of breath. Digitalis preparations to strengthen cardiac output, beta-blockers to normalize heart rate and ACE inhibitors to lower blood pressure are particularly successful.
Psychological causes should primarily be treated through behavioral and conversation therapies. A change in lifestyle and eating habits can also be part of a corresponding behavioral therapy, provided that unhealthy everyday habits such as improper nutrition, nicotine consumption or stress have been identified as triggers of breathlessness. In addition, it is sometimes necessary for patients to learn to breathe normally again. This is particularly important for long-term protection or chronic respiratory diseases.
Operative methods are used primarily for serious causes of illness. Depending on the cause, it may even be essential to save the patient's chest or neck in order to save a person's life, for example in the event of an allergy (for example, wasp stings are used for wasp stings) or severe lung diseases such as tumor diseases. Here, surgery is usually preceded by chemotherapy treatment in order to reduce the size of the tumor before the procedure.
Another possible surgical or invasive measure for the treatment of dyspnea is the removal of the tonsils with recurrent inflammation. A tracheotomy is also used not only to secure breathing in allergy-related swellings, but also in general for artificial ventilation during operations or serious respiratory diseases. In this context, it may also be necessary to insert valves or stents to keep the airways open. The creation of a drainage for draining air, blood or pleural secretion is essential for pleural effusions, pneumo- or hematothorax.
Stress and obesity-related shortness of breath can be minimized in terms of expression and frequency by a few relatively easy-to-use measures. Of course, it should be noted at this point that the measures for those affected themselves are generally anything but easy to apply. Nevertheless, they should be listed here:
- Weight reduction: If obesity is the cause of the breathing problems, a reduction in body weight to improve breathing is of course a top priority. If necessary, outside help should also be sought, for example from nutritionists, sports coaches or specialists.
- Change in eating habits: closely related to being overweight, but also with numerous diseases that can lead to shortness of breath (e.g. heart disease), is an incorrect diet. In many cases, a balanced diet also helps to improve shortness of breath. Above all, antioxidative foods such as berries, tropical fruits, tomatoes, broccoli and nuts strengthen the heart and lungs and can thus improve breathing again. The situation is similar with omega fatty acids. They are mainly found in seafood and fish. In addition, too low a phosphorus or magnesium level can be bad for breathing. Corresponding foods that contain a particularly large amount of these two minerals include, in addition to fish, seafood, dairy products and nuts, above all legumes such as beans or peas, whole grain cereals, carrots and spinach.
- Reduce stress: Everyday stress should be avoided if possible, especially as a result of heart disease. Therefore, always plan sufficient periods of rest in your everyday life and place additional value on targeted relaxation measures such as yoga, reiki or meditation. A healthy sleep pattern can also help reduce the risk of heart and breathing problems.
- Stop intoxication and luxury goods consumption: It goes without saying that patients suffering from shortness of breath should definitely stop smoking. In addition, other stimulants and intoxicants are not exactly beneficial when it comes to breathing difficulties. In addition to cigarettes, the consumption of alcohol, caffeine and drugs must therefore be assessed critically.
Naturopathy can stand up to the shortage of air when the causes are inflammation of the respiratory tract. In addition to the use of teas, sweets, throat rinses and steam baths with herbs that relieve the respiratory tract, such as thyme, eucalyptus and sage, honey in particular is considered an all-round talent. It not only alleviates complaints in the upper respiratory tract, but also attacks the mucus in the lower respiratory tract. Even in the treatment of asthma, honey has had good success in this regard. A special tip is Manuka honey. It is made from the Manuka coniferous plant of the same name, which is mainly found in Australia and New Zealand, and Manuka honey is known in its home country as both a secret weapon against skin problems and against respiratory complaints. Above all, the expectorant properties of Manuka have been scientifically proven.
Shortness of breath diseases
In many diseases, shortness of breath is a typical symptom, these include, among others: bronchial asthma, bronchitis, COPD, laryngitis, pulmonary embolism, pulmonary emphysema, pulmonary fibrosis, pulmonary edema, pharyngitis, pleurisy, pneumothorax, sarcoidosis, tumor diseases of the respiratory tract, arteriosclerosis, arteriosclerosis, arterial disease, arterial disease, arterial disease , High blood pressure, heart failure, heart valve defects, pericarditis, myocarditis, coronary artery disease, pericardial effusion and hyperthyroidism. (ma)
Author and source information
This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
- Noah Lechtzin: Dyspnoe, MSD Manual, (accessed August 22, 2019), MSD
- Mark B. Parshall et al .: An Official American Thoracic Society Statement: Update on the Mechanisms, Assessment, and Management of Dyspnea, American Journal of Respiratory and Critical Care Medicine, (accessed August 22, 2019), PubMed
- Daniela Schön et al .: Reduced Perception of Dyspnea and Pain after Right Insular Cortex Lesions, American Journal of Respiratory and Critical Care Medicine, (accessed August 22, 2019), PubMed
- Federal Chamber of Physicians (BÄK), National Association of Statutory Health Insurance Physicians (KBV), Working Group of the Scientific Medical Societies (AWMF): National Care Guideline Chronic Heart Failure - Long Edition, 2nd Edition, Version 3, 2017 (accessed 22.08.2019), DOI: 10.6101 / AZQ / 000405. , AWMF
ICD codes for this disease: R06.0ICD codes are internationally valid encodings for medical diagnoses. You can find yourself e.g. in doctor's letters or on disability certificates.