Dyspnea, which everyone refers to as shortness of breath, is an uncomfortable feeling of not getting enough air. It is not a condition, but a sign of an underlying cause. Shortness of breath can be caused by problems with the heart, lungs, blood, or muscles, or by a panic attack. Determining the cause of tinnitus is key to successful treatment.

Why Do We Feel Breathless? – Common Causes

Dyspnea is a natural symptom during heavy exercise; however, it becomes pathological when occurring under non-expected conditions, such as at rest or with little exertion.

Some respiratory distress can be caused by systems in the body, a few of which overlap with symptoms.

Respiratory (Lung-related) Causes

Asthma

COPD (Chronic Obstructive Pulmonary Disease)

Pneumonia

Interstitial Lung Disease (ILD)

Pleural effusion

Lung cancer, pneumothorax, pulmonary embolism

Clues: Cough, wheezing, chest pain or tightness, a history of smoking or allergies.

Cardiac (Heart-related) Causes

Congestive Heart Failure (CHF)

ACS=acute coronary syndrome, MI=myocardial infarction.

Arrhythmias

Valvular heart diseases

Signs: Chest pain, palpitations, fatigue, leg swelling; can lie flat but wakes up breathless in the middle of the night (PND).

Neuromuscular Causes

Diseases of the muscles or nerves that control breathing, such as diaphragmatic paralysis, muscular dystrophies, or skeletal abnormalities (for example, advanced kyphoscoliosis). GB syndrome ALS

Systemic Causes

Anemia

Acidosis

Chronic kidney disease

Sepsis (severe infection)

These conditions limit the oxygen supply or raise the organism's oxygen demand.

Psychogenic Causes

Feelings of hunger for air, which can be provoked by anxiety, panic attacks, or hyperventilation syndrome, even when oxygen levels are normal.

Occupational and Environmental Causes

Chronic exposure to dust, chemicals, and industrial pollutants as seen with silicosis, asbestosis, pneumoconiosis, or occupational asthma.

How Is Breathlessness Evaluated?

A thorough evaluation includes:

Detailed Medical History

Key questions include:

Duration of symptoms:

≤ 2 weeks) Usually caused by: acute infections, asthma exacerbations, and pulmonary embolism.

Chronic (> 2 weeks) – COPD, HF, ILD, and anaemia.

Triggers: Exercise, allergens, lying down, andemotional stress.

Past allergies, smoking, occupational exposure

Accompanying symptoms: Cough, fever, chest pain, palpitations, leg swelling.

Physical Examination

An initial evaluation includes a review of the airway, breathing, and circulation and then an assessment of history and physical examination. Signs and symptoms that are clinically destined for severeity - Low BP, Reduced Oxygen saturator, Change in mental status, arrhythmia,stridor bluish accumulation etc.

Doctors look for:

• Rate of respiration, use of the accessory muscles of respiration
• Wheezing, crackles on lung auscultation
• Heart murmurs, pulse irregularities
• Cyanosis (bluish discoloration), pedal edema
• Spinal or chest wall deformity signs

Investigations

To ascertain the exact cause, the tests listed below are frequently performed.

Basic Tests:

Chest X-ray

Complete Blood Count (CBC)

Arterial Blood Gas (ABG) analysis

Renal Function Tests (RFTs)

D dimer

NT Pro BNP

Lung-focused Tests:

Spirometry / Pulmonary Function Tests

CT scan of the chest

Heart-focused Tests:

ECG (Electrocardiogram)

Echocardiography (ECHO)

Treadmill Testing (TMT) or Stress Test

Why Early Evaluation Matters

Failing to investigate a breathlessness can lead to delayed diagnosis of serious conditions such as heart disease, lung fibrosis or cancer. Early evaluation helps:

Prevent complications

Start appropriate treatment sooner

Life and Survave or increase quality of life

When to Seek Medical Help?

You should see a doctor if breathlessness:

Happens suddenly or severely

Is accompanied by chest pain, passing out or lips that appear blue

Worsens with routine activity

Interrupts sleep (orthopnea or PND)

Occurs with unexplained weight loss, fever or persistent cough

Breathlessness is more than just tiredness. It's a signal from your body that something needs attention-whether in the lungs, heart, blood, nerves, or mind. Timely evaluation, early diagnosis, and proper treatment can help you breathe easier and live fuller.

-Dr Ashwini Colaco, Pulmonologist, Manipal Hospital, Goa

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