“Doctor, I’m always out of breath!”
“Oh, yes? Tell me more…”
A Baffling Symptom
Shortness of breath is indeed a symptom that can be challenging to describe, and pinpointing its underlying cause can be puzzling.
Breathing Comes Naturally. We Never Give it a Second Thought!
It’s fascinating to note that, often without conscious awareness, we breathe an average of 15 times per minute. This automatic regulation of breathing is managed by the respiratory control center located in the lower part of the brainstem, known as the spinal bulb or medulla oblongata.
In addition to this involuntary control, we also possess the ability to voluntarily control our breathing. This voluntary regulation occurs in the brain. Remarkably, if we momentarily “forget” to breathe, the autonomous breathing center swiftly takes over to ensure our continued respiratory function.
Several Questions Should Be Asked
Breathlessness is a subjective symptom, meaning it can be felt by the individual experiencing it but cannot be objectively measured. Moreover, the perception of breathlessness varies from one patient to another.
During a consultation, the doctor will work to clarify the situation by engaging in dialogue with the patient. This allows the doctor to ask specific questions, conduct a physical examination, and order any relevant tests deemed necessary.
Several key factors assist the healthcare professional in understanding the nature of the breathlessness. These include the duration of time the patient has experienced the symptom and how it has progressed over time. Additionally, the presence of any accompanying symptoms, such as coughing, fever, weight loss, or chest pain, can provide valuable insights into the underlying cause of the breathlessness.
The patient should also describe the circumstances in which they experience shortness of breath: during intense physical exertion, while engaging in sporadic activity, climbing stairs, during personal hygiene activities, or even just while talking.
It is essential for the patient to note the activities they can no longer perform or that they perform with difficulty due to significant shortness of breath.
Various Levels of Breathlessness
Following the assessment, the doctor can classify the severity of shortness of breath into four categories: intense exertion, moderate exertion, mild exertion, or resting exertion.
By monitoring the evolution of breathlessness symptoms over time, the doctor can track any improvements, stabilizations, or deteriorations.
In the case of chronic illness, worsening shortness of breath prompts the doctor to reassess the patient’s treatment and, sometimes, to prescribe additional tests to confirm the progression of the disease and adjust the treatment accordingly.
Several Causes Are Possible
Shortness of breath typically arises from one or a combination of causes. It can stem from lung or heart issues, declining physical fitness, or emotional factors such as anxiety, distress, or the natural aging process.
In older individuals, heart-related problems may not always be the primary cause of shortness of breath. Instead, factors such as aging itself with decreased physical fitness play significant roles in contributing to this symptom.
Therefore, a comprehensive evaluation is essential to identify the underlying factors and tailor an appropriate treatment plan.
Physical Deconditioning
Deconditioning isn’t a disease per se, but rather a consequence of reduced physical activity or prolonged inactivity. Fortunately, the benefits of regular physical activity become evident quite swiftly.
When the Condition of the Heart Is Responsible
When shortness of breath is caused by underlying heart problems, such as heart failure due to poor heart muscle function or an overload of the bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood volume to be ejected (valvular insufficiency), or even a combination of both, it can have repercussions on the lungs.
In these situations, the heart’s inability to pump bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood effectively can lead to fluid buildup in the lungs, which can contribute to shortness of breath and other respiratory symptoms. This may manifest as difficulty breathing, wheezing, or a feeling of chest tightness.
When we Breathe…
Let’s simplify all of this.
Breathing is the process of inhaling oxygen from the air and exhaling carbon dioxide from the body. These essential gas exchanges occur within approximately 600 million tiny air sacs called pulmonary alveoli, located in the lungs.
Surrounding these microscopic sacs are tiny bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood vessels known as pulmonary capillaries. As bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood flows through these capillaries, it comes into close contact with the air in the alveoli. This proximity allows for the exchange of gases: carbon dioxide diffuses from the bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood into the alveoli to be exhaled, while oxygen moves from the alveoli into the bloodstream to be carried throughout the body.
This intricate exchange process ensures that the bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood is constantly replenished with oxygen and rid of carbon dioxide, supporting vital functions throughout the body.
A Sick Heart
When the heart’s pumping function is compromised, such as in the case of heart failure, fluid may accumulate in the space between the pulmonary capillaries and the alveoli in the lungs.
Water in the Respiratory System
This accumulation of fluid, known as pulmonary edema, interferes with the exchange of gases in the alveoli. This leads to a decrease in bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood oxygen levels and an increase in carbon dioxide levels.
On-site Detectors
Indeed, the presence of excess fluid in the alveolar-capillary space activates small sensors known as pulmonary stretch receptors. These receptors detect changes in lung volume and send signals to the brain’s respiratory center.
The purpose of this message is to stimulate an increase in breathing rate, leading to the sensation of breathlessness. It’s important to note that this sensation can occur even if the amount of excess fluid is not large enough to significantly impair oxygen and carbon dioxide exchange.
In the most severe cases, it can even feel like you are running out of air.
Coughing and Wheezing
In addition to breathlessness, individuals experiencing fluid accumulation in the alveolar-capillary space may also present with coughing and wheezing. Wheezing is characterized by a high-pitched whistling sound during breathing and is reminiscent of the breath sounds observed in asthmatic patients.
These symptoms can further indicate respiratory distress and the need for medical evaluation and intervention.
Two Other Types of Breathlessness
In addition to experiencing breathlessness during different levels of physical activity, individuals with heart issues may encounter two other types of breathlessness:
- Difficulty breathing when lying flat: Some patients find it challenging to breathe when lying flat, a condition known as orthopnea. To alleviate this discomfort, they may use extra pillows to prop themselves up while sleeping. In more severe cases, individuals may opt to sleep in an upright position in an armchair to ease their breathing.
- Sudden respiratory distress during the night: Some patients may experience sudden and severe shortness of breath during sleep, a phenomenon called paroxysmal nocturnal dyspnea (PND).
These types of nighttime shortness of breath can be signs of heart decompensation and require urgent medical evaluation to determine the underlying cause and adjust the treatment if necessary.
Call 911
In the event of sudden, severe, and unrelenting shortness of breath, it is crucial for the individual to seek immediate medical attention at a hospital emergency room.
This symptom could indicate a serious underlying medical condition that requires prompt evaluation and treatment by healthcare professionals.
