BREATHING DIFFICULTIES
Shortness of breath, what doctors call dyspnea is the unpleasant sensation of having difficulty breathing. People may experience and describe shortness of breath differently depending on the cause.
The rate and depth of breathing normally will increase during exercise and at high altitudes, but the increase hardly causes any discomfort. Breathing rate is also increased even at rest in people with many disorders. For example, people with fever generally will breathe faster.
With dyspnea, the fast breathing is accompanied by the sensation of running out of air. The afflicted people feel as if they cannot breathe fast enough or deeply enough. They may notice that more effort is needed to expand the chest when breathing in or to expel air when breathing out. They may also have the uncomfortable sensation that inhaling is urgently needed before exhaling is completed and have some sensations often described as tightness in the chest.
Depending on the cause of dyspnea, other symptoms, such as cough or chest pain, may be experienced. There is no standard definition for difficult breathing. Some people feel breathless with even mild exercise (e.g. climbing stairs), even though they do not have any medical condition. Others may have advanced lung disease, but they may never feel short of breath.
One form of breathing difficulty in which one makes a high-pitched sound when exhaling is wheezing.
Wheezing can either be a normal healthy response to an unhealthy environment, or can be a sign of asthma. Well to understand that, first let's all take a deep breath together (inhales). When a person breathes in, the air comes through the nose or mouth, through the big windpipe and breaks into 2 big bronchi, one into each lung. From there they break into little, smaller bronchioles. Those bronchioles are where the wheezing happens. Now if that person happens to walk into a cloud of something that is toxic, the body is going to respond instantly to try to protect itself. The first thing that will happen is the muscles around the bronchioles will tighten, and that is when he/she gets the tight airways. If that toxic cloud is still there, swelling of the lining will happen, so as to protect the delicate tissues deep in the lungs. If the toxic cloud is still there and still irritating, mucus will begin to be secreted to be able again to capture and protect from those toxins. That's wheezing.
Asthma happens when a person's airways are hyper-responsive. When they're hyper-alert and they respond to things that may not truly be dangerous. The problem with that is when the bronchioles are constricted and swollen and has mucus in them, the narrow little opening becomes hard to breathe through. One has to work to breathe, especially to exhale. And that hard breathing through a narrow passageway is what creates the sound we know and refer to as wheezing.
CAUSES
- Asthma
Generally defined as a common, chronic respiratory condition that causes difficult breathing due to inflammation of the airways. Asthma symptoms include dry cough, wheezing, chest tightness and shortness of breath. Allergic reactions, infections and pollution can all trigger an asthma attack.
Experienced medical professionals opine that those with persistent asthma often notice a better quality of life with the help of anti-inflammatory medication. Everyone who has asthma needs to have a rescue inhaler to open their airways quickly.
Asthma typically begins in childhood years and progresses into adulthood. However, some people can get adult onset asthma at age 60, 70 and even 80. Some specialists say asthma is a reversible obstructive lung disease. That they have seen asthma patients who are able to improve the flow rates of their breathe better than those who have the respiratory disease known as COPD.
- Chronic Obstructive Pulmonary Disease (COPD)
COPD is an umbrella term which encompasses several respiratory illnesses that cause breathlessness, or the inability to exhale normally. People experience symptoms that includes shortness of breath, and normally would cough up sputum (mucus from the lungs), especially in the morning. COPD can be difficult for people to identify, because the symptoms are often mistaken for the gradual aging process and body deterioration. In fact, COPD can develop over the course of several years without any signs of shortness of breath. For that reason, some experts say COPD often goes undetected for too long. He says the disease usually begins while people are in their 30s or 40s and then peaks during their middle age. Commonly, this disease is associated with cigarette smoking. It is quite rare to see people with COPD who have not been exposed to some sort of smoking.
Treatment includes to quit smoking, medication that opens the airways (bronchodilator therapy). COPD is not reversible. It is reputed to be one of the most serious and dangerous respiratory illnesses.
A very serious disease, it continues to worsen, even when one quits smoking.
- Chronic Bronchitis
This is a form of COPD characterized by a chronic cough. Usually people cough up sputum (mucus from the lungs), especially in the morning. This happens because mucus glands in the airways increase their output, and patients have to cough out that extra secretion. People can also develop acute bronchitis, which is not a long-term disease but instead an infectious problem. It develops from a viral or bacterial infection and can be treated with antibiotics. Symptoms associated with acute bronchitis will subside once the infection has been resolved.
- Emphysema
Another form of COPD, Emphysema is a serious respiratory disease. The most common cause again, is smoking. Those who suffer from emphysema have trouble exhaling air from their lungs. Cigarette smoke goes to damage the air sacs in the lungs to a point where they can no longer repair themselves. This respiratory system illness most commonly leads to respiratory failure and the need for extra oxygen to meet breathing needs. Emphysema is a disease that evolves slowly over the years. There is actually no cure; however, those who quit smoking are more likely to see the disease's progression slowed.
- Lung Cancer
With the special ability to develop in any part of the lungs, this cancer is quite difficult to detect. Often times, the cancer develops in the main part of the lungs near the air sacs. Mutations of DNA in the lungs cause irregular cells to multiply and create an uncontrolled growth of abnormal cells (tumor). These tumors interfere with the regular functions of the lungs.
By far, the most common risk factor for lung cancer is cigarette smoke. Other risk factors may include exposure to radon, exposure to harmful substances at the workplace, (e.g. asbestos and diesel fumes), secondhand smoke, polluted air and exposure to radiation from frequent CT scans of the chest etc.
Symptoms like chronic coughing, changes in voice, harsh breathing sounds and coughing up blood can take years to appear.
- Cystic Fibrosis/Bronchiectasis
This happens to be a genetic respiratory disease caused by a defective gene that creates thick and sticky mucus that clogs up tubes and passageways. This mucus causes repeated and dangerous, lung infections, as well as obstructions in the pancreas that prevent important enzymes from breaking down nutrients for the body. Symptoms of cystic fibrosis may include skin that tastes salty, chronic cough, frequent lung infections and poor growth in children.
Bronchiectasis, a condition in which patients develop abnormally enlarged bronchial tubes. This allows mucus to pool, thus causing frequent respiratory tract infections, wheezing and shortness of breath.
The experts say, bronchiectasis usually develops later in life and is more common among women.
- Pneumonia
Pneumonia is a common lung disease that is caused by an infection in the air sacs inside the lungs. These infections can be bacterial, viral or fungal. Most people can recover in a period up to three weeks, however for certain people, pneumonia can even be life-threatening.
Based on their smoking history or their overall immune status, patients can be increasingly susceptible to pneumonia. People may develop pneumonia more readily than the young, healthy, well-nourished people if they are frail or sickly.
Symptoms, of pneumonia include cough, fever, shaking chills and shortness of breath. The symptoms range from mild to severe. Apart from getting the pneumococcal pneumonia vaccine, other suggested ways to prevent this respiratory condition include frequent washing of hands and getting the flu shot.
- Pleural Effusion
Pleural effusion is the collection of fluid in what's called the pleural space (between the lung and the chest wall). This could happen for a variety of reasons, including pneumonia, cancer or congestive heart failure. Usually patients notice symptoms of increasing chest discomfort and shortness of breath. Those diagnosed with this condition usually undergo a procedure to remove the fluid, which allows the lung to expand again thus allowing the patient to breathe better. The fluid would be tested in a laboratory to determine the cause and treatment.
- COVID-19
COVID-19 is new relative to all the causes mentioned above, and the world is still struggling to understand the virus in its ramifications. According to health experts, COVID-19 is a respiratory illness that belongs to a large family of viruses called coronaviruses. This type of virus infects humans as well as animals, but this latest strain has not been seen among humans before now. What has been established is that, the virus spreads mainly from person-to-person between people who are in close contact with one another (within about 2 metres). Like other viruses, COVID-19 spreads through droplets released when an infected person coughs, sneezes or talks. The primary symptoms are cough, shortness of breath and fever.
People with these symptoms listed below should call ahead of visiting a health care facility;
- Pulmonary hypertension
- Pulmonary edema (excess fluid in the lungs)
- Heart problems
- Lung problems
- Croup (especially in children)
- Lung cancer
- Pleurisy (inflammation of the membrane surrounding the lungs)
- Pulmonary fibrosis (scarred and damaged lungs)
- Sarcoidosis (collections of inflammatory cells in the body)
- Tuberculosis
- Cardiomyopathy (problem with the heart muscle)
- Heart failure
- Pericarditis (inflammation of the tissue around the heart)
Other problems;
- Anemia
- Broken ribs
- Epiglottitis (swelling of the 'lid' of the windpipe)
- Guillain-Barre syndrome
- Kyphoscoliosis (a chest wall deformity)
- Myasthenia gravis (a condition causing muscle weakness)
Symptoms
The primary symptom of breathing problems is the feeling as though one cannot breathe in enough oxygen. Some specific signs include:
- Wheezing
- A pale or gray complexion
- Blue fingernails or lips
- A faster breath rate
- Profuse sweating
- Flaring nostrils
Some of the symptoms that come along with breathing difficulty may indicate a serious problem. These problems may be an angina attack, a lack of oxygen, or a heart attack. Symptoms to be aware of include:
- Shortness of breath that wakes one up during the night
- A barking cough
- Fever
- Pain or pressure in the chest
- Wheezing
- Tightness in the throat
- Shortness of breath
WHEN TO SEE A DOCTOR
People who experience severe shortness of breath that comes on suddenly and affects the ability to function should call their local emergency number or have someone drive them to the nearest health facility to seek emergency medical care. Especially so if the shortness of breath is accompanied by chest pain, fainting, nausea, a bluish tinge to lips or nails, or a change in mental alertness (these may be signs of a heart attack or pulmonary embolism).
Still make an appointment with a doctor if the shortness of breath is accompanied by:
- High fever, chills and cough
- Swelling in the feet and ankles
- Trouble breathing when one lies flat
- Wheezing
- Worsening of pre-existing shortness of breath
SELF-CARE
To help keep chronic shortness of breath from getting worse:
- Cease smoking – People should quit smoking, or must not begin if they intend to. Smoking is the leading cause of COPD. If one has COPD, quitting can slow the progression of the disease and prevent further complications.
- Avoid exposure to pollutants - As much as possible, avoid allergens and environmental toxins, such as chemical fumes or secondhand smoke.
- Avoid temperature extremes - Very hot, humid or very cold conditions may amplify the dyspnea caused by chronic lung diseases.
- Keep altitudes in mind - When traveling to areas with higher altitude, take time to adjust and avoid exertion until then.
- Regular exercise - Exercise improves physical fitness and the ability to tolerate activity. Together with weight loss exercise may help to properly condition a person so as to reduce shortness of breath that may be due to deconditioning.
- Take medications promptly - Skipping medications for chronic lung and cardiac conditions can lead to poorer control of dyspnea.
- Regularly check relevant equipment - If one relies on supplemental oxygen for instance, or some other equipment to manage a condition, be sure of adequate supply and ensure that the equipment works properly.
DIAGNOSIS
The doctor will need to determine the underlying cause of the breathing difficulty. He will therefore ask to know how long the problem has persisted, its level of intensity, and whether or not physical exertion makes it worse.
The doctor will examine patient's airway passages, lungs, and heart after reviewing the medical history.
Depending on the findings of the physical exam, the doctor might recommend one or more diagnostic tests which may include:
- Pulmonary function tests
- Electrocardiogram (ECG or EKG)
- Blood tests
- Chest X-ray
- CT scan
- Echocardiogram
As part of diagnosis, the doctor may also have the patient perform physical exercise to see how the heart and lungs react to physical exertion.
TREATMENT
Things that cause breathing difficulties are known as triggers. The avoidance of triggers is the first rule to the control of allergies and asthma. From the wearing of dust masks when doing housework, limiting contact with a furry pet, to washing the bed linens at least once a week, or staying indoors during peak pollen times, these lifestyle adaptations can help control allergies that cause breathing difficulties.
Medications are also important in treating breathing problems. Antihistamines and decongestants in the form of oral or nasal allergy drugs may make it easier for a person to breathe.
Whereas inhaled steroids can help reduce inflammation in the airways, allergy shots may ease some breathing problems by lowering a person's sensitivity to allergens.
For asthma patients, inhaled or oral drugs help open the airways and fight inflammation. These are medications that help ease or even prevent airway blockage and extra mucus. People who have asthma must control inflammation in order to keep their airways open and lower sensitivity to triggers such as:
- Smoke
- Irritating pollutants in the air
- Food allergies
- Viral infections (cold or flu)
- Pollen
- Mold spores
- Dust mites
- Cockroaches
- Pet dander
- Fragrances and fumes
Even simple things like exercise and cold weather can trigger asthma in some people. Treatments for breathing difficulties will depend on the underlying cause.
Lifestyle changes
If having a stuffy nose, exercising too hard, or hiking at high altitudes causes the symptoms being experienced, normal breathing is likely to return to once the cold goes away, the exercising stops, or the person returns to a lower altitude.
Stress reduction
A person can reduce stress by developing coping mechanisms if stress is causing the breathing problems. A few ways to relieve stress include:
- Exercise
- Meditation
- Counseling
- Listening to relaxing music or talking to a friend
- Bird watching
Medication
Some breathing difficulties are symptoms of very serious heart and lung illnesses. In these cases, the doctor will prescribe medication as well as other treatments. An asthma patient for example, may need to use an inhaler immediately after experiencing breathing problems.
For a person with allergies, the doctor may prescribe an antihistamine to reduce the body's allergic reaction. In extreme cases, a person may need oxygen therapy, a breathing machine and monitoring at a hospital facility.
If a child is experiencing mild breathing difficulties, parents may want to try some soothing home remedies before seeking treatment from a doctor. Cool or moist air can help. Take the child outside into the night air or into a steamy bathroom.
PREVENTION
The most obvious risk factor for shortness of breath is smoking. Smokers should find a smoking cessation specialist or program. There are many effective products and therapies now that can help smokers quit.
Air pollution and airborne chemicals can also cause breathing problems. So people should consider using a mask to filter out lung irritants, and make sure the workplace is well-ventilated.
Maintaining a healthy weight can help avoid a number of health problems. If there is need for help to lose weight, talk with the doctor about using a nutritionist or dietitian.
