“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
Shortness of breath is a subjective symptom, meaning that it is experienced by the person but cannot be measured objectively. Its perception varies from one person to another.
During a medical consultation, the physician will clarify the situation by asking questions, performing a physical examination, and ordering any additional tests considered necessary.
Certain details are particularly useful to the healthcare professional. It is important to determine when the symptom first appeared and how it has changed over time. The physician will also look for other symptoms, such as cough, fever, weight loss, or chest pain.
The patient should also describe the circumstances in which difficulty breathing occurs: during strenuous physical activity, while exercising, when climbing stairs, during personal care activities, or simply while talking.
It is also important to identify activities that have become difficult or impossible to perform because of this limitation.
Assessing Severity
The physician can classify the severity of shortness of breath into four categories: during strenuous, moderate, or light activity, or at rest.
This classification helps track symptoms over time and determine whether they are improving, remaining stable, or worsening.
In the presence of a chronic condition, worsening symptoms may prompt the physician to reassess the situation and, in some cases, order additional tests to evaluate its progression and adjust 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 a heart problem, such as heart failure related to reduced heart muscle function or volume overload due to valvular insufficiency, the lungs may also be affected.
In these situations, the heart is unable 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 as effectively, which can lead to fluid buildup in the lungs. Breathing then becomes more difficult and may be accompanied by wheezing or a feeling of tightness in the chest.
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 Particular Situations
When a heart problem is present, difficulty breathing does not occur only during physical activity. Two situations are particularly important to recognize:
- Shortness of breath when lying down
Some people have more difficulty breathing when lying flat. Adding pillows often helps relieve the discomfort. In more severe cases, they may need to sleep in a chair to keep the upper body in a more upright position.
- Sudden shortness of breath at night
Some people are awakened during the night by sudden and significant difficulty breathing. They may feel the need to sit up or stand to obtain relief.
These manifestations may be a sign that the heart condition is worsening and require medical evaluation to determine the cause and adjust treatment, if necessary.
Call 911
Sudden, severe, and persistent difficulty breathing may be a sign of a serious problem. Call 911 without delay to receive prompt medical attention.
Do not hesitate to seek medical assistance if you experience concerning respiratory symptoms.
