What Do I Do When It's Hard to Breathe?

If it is hard to breathe it’s important to see a doctor to diagnose the cause and receive proper treatment. Some causes of breathing difficulty can be life-threatening. Difficulty breathing (dyspnea) may be characterized by shortness of breath, difficulty getting a breath in, or pain when breathing and can be a sign of a serious medical condition.

Difficulty breathing (dyspnea) may be characterized by shortness of breath, difficulty getting a breath in, or pain when breathing and can be a sign of a serious medical condition. Shortness of breath may be acute (sudden dyspnea) or chronic (long-term dyspnea).

If it is hard to breathe it’s important to see a doctor to diagnose the cause and receive proper treatment. Some causes of breathing difficulty can be life-threatening.

Symptoms of difficulty breathing include:

• Shortness of breath 
• Pain when breathing
• Feeling unable to breathe properly/inhale deeply
• Wheezing
• Rapid, shallow breathing 
• Increased effort to breathe
• “Air hunger”
• Heavy breathing
• Feeling of suffocation

Symptoms that may accompany difficulty breathing include:

• Cough
• Chest pain/tightness
• Sweating
• Blue lips or nails
• Pale skin
• Sputum production
• Stuffy nose
• Swelling of extremities 
• Raynaud’s phenomenon (cool blue extremities)
• Joint swelling
• Muscle weakness 

When it’s hard to breathe, see a doctor immediately or call 911 if you have difficulty breathing and: 

• Symptoms have a sudden onset
• Pain or pressure in the chest
• Fever
• Swelling in your feet and ankles
• Trouble breathing when you lie flat
• Chills
• Cough
• Wheezing
• Is associated with itching, hives, or facial/lip swelling
• Feeling like your throat is swollen
• Shortness of breath becomes more severe
• Palpitations
• Lightheadedness or feeling faint
• Is accompanied by severe confusion, chest or jaw pain, or pain down your arm

Emergency causes for difficulty breathing include:

• Head, eyes, ears, nose, and throat (HEENT):
  • Angioedema
  • Severe allergic reaction (anaphylaxis)
  • Throat infections 
  • Deep neck infections
  • Foreign body in airway (choking)
  • Neck trauma
  • Chest wall
  • Rib fractures
  • Flail chest
• Pulmonary (lung-related)
  • Chronic obstructive pulmonary disease (COPD) 
  • Asthma exacerbation
  • Blood clot in the lung (pulmonary embolism, or PE)
  • Collapsed lung (pneumothorax)
  • Lung infection by bacteria, virus or fungus
    • COVID-19 coronavirus infection
  • Acute respiratory distress syndrome (ARDS)
  • Pulmonary contusion or other lung injury
  • Bleeding (hemorrhage)
• Cardiac (heart-related)
  • Acute coronary syndrome
  • Acute decompensated heart failure
  • Flash pulmonary edema
  • High output failure
  • Cardiomyopathy
  • Arrhythmia
  • Valvular dysfunction
  • Cardiac tamponade
• Neurologic
  • Stroke
  • Neuromuscular disease
• Toxic/metabolic
  • Organophosphate poisoning 
  • Salicylate poisoning
  • Carbon monoxide (CO) poisoning
  • Toxic ingestion
  • Diabetic ketoacidosis
  • Sepsis
  • Anemia
  • Acute chest syndrome
• Miscellaneous
  • Hyperventilation
  • Anxiety
  • Pneumomediastinum
  • Lung tumor
  • Pleural effusion
  • Ascites
  • Pregnancy (not a cause of dyspnea but may worsen it)
  • Massive obesity (not a cause of dyspnea but may worsen it)

The five most common causes of chronic breathing difficulty (dyspnea) include:

• Asthma 
• Chronic obstructive pulmonary disease (COPD) 
• Interstitial lung disease 
• Heart problems
• Obesity/deconditioning 

It is important to diagnose the underlying cause of why it is hard to breathe in order to determine treatment. In addition to a physical examination, tests may include: 

• Chest X-ray
• Ultrasound 
• Electrocardiogram (ECG) 
• Blood tests
  • Cardiac biomarkers (e.g., troponin I) 
  • Brain natriuretic peptide (BNP) 
  • D-dimer 
  • Arterial and venous blood gas 
• Carbon dioxide monitoring 
• Chest computerized tomography scan (CT) 
• Pulmonary ventilation/perfusion (V/Q) scan
• Negative inspiratory force (NIF) 
• Multidetector computed tomography (MDCT) scan of the chest 
• Peak flow and pulmonary function tests (PFTs) 

Tests for chronic shortness of breath depend on the suspected cause and may include any of the above tests, as well as: 

• Blood tests 
  • Complete blood count 
  • Glucose, blood urea nitrogen, creatinine, electrolytes
  • Thyroid stimulating hormone (TSH)
• Spirometry pre and post inhaled bronchodilator 
• Pulse oximetry during ambulation at a normal pace over approximately 200 meters and/or up two to three flights of stairs

Treatment for acute difficulty breathing in an emergency setting usually includes:

Oxygen 

• Determining if the patient needs emergency airway management and ventilatory support
• Establishing the most likely causes of the difficulty breathing and initiating treatment

Treatment for chronic breathing problems varies widely depending on the cause. For example:

• If chronic difficulty breathing is caused by asthma, that may be treated with medications such as bronchodilators or inhaled steroids 
• If chronic difficulty breathing is caused by a blood clot (pulmonary embolism), you may need blood thinners
• If chronic difficulty breathing is caused by fluid in the lungs, that fluid may need to be drained

Complications of difficulty breathing include:

• Low blood oxygen (hypoxia)
  • Loss of consciousness
• Brain Damage
  • Cognitive impairment 

Some causes of difficulty breathing may be prevented, and in doing so, this will prevent difficulty breathing from developing or worsening. 

• Don’t smoke or quit smoking
• Lose weight and maintain a healthy weight
• Avoid allergens
• Practice stress reduction techniques