What Are Breathing Difficulties? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Feeling as if it’s hard to catch your breath for a minute or two is not unusual, especially if you’ve been exercising or doing similar activities such as vigorously cleaning the house or carrying heavy bundles. That’s because when we exert ourselves, our muscles require more oxygen than they do when we are at rest. Our breathing rate momentarily quickens, and our heart beats faster to meet that need.

But if it’s hard to catch your breath for longer than a few minutes, it may be due to other causes. Oftentimes, those causes are easily fixable or explainable. You may, for example, simply need to loosen a too-tight belt or take it a little easier after spending a long time in bed.

In other cases, however, breathlessness — what doctors call dyspnea — may signal the presence of an underlying health problem such as a respiratory illness, heart disease, allergies, or obesity.

“Just feeling tired or feeling worn out or weak is not shortness of breath," says pulmonologist Roger Maxfield, MD, a professor of medicine at Columbia University Medical Center in New York City. "And even if you feel like you can’t get enough air for a little bit after an activity, that’s okay. But if you’re short of breath at rest or you’re breathing as hard and deep as you can and you just don’t get enough air, that’s something that requires professional medical attention.”

In addition to feeling as if you cannot take in enough air, symptoms of dyspnea, according to the journal American Family Physician, can include the following: (1)

• Rapid breathing
• Increased heart rate
• Gasping
• Anxiety or panic, which can make breathing even more difficult

How can you know if your shortness of breath warrants medical attention? “If you can speak full sentences comfortably, then it’s likely not a medical emergency,” says family physician Sachin Nagrani, MD, medical director of the national healthcare company Heal. “But it is something that generally should be evaluated by a medical professional due to the range of things that can cause shortness of breath.”

If you have a chronic condition associated with breathing problems such as chronic obstructive pulmonary disease (COPD), a certain level of breathlessness may be normal for you, adds Geoffrey Mount Varner, MD, an emergency room physician in the Washington, DC, metropolitan area. Any worsening of preexisting symptoms, however, is cause for concern. “If you often experience feeling winded when you walk to your refrigerator, for example, it is likely your baseline,” Dr. Varner explains. “But if shortness of breath is getting worse — if you noticed you get it when walking to the refrigerator and now you also feel shortness of breath when sitting, that’s a sign it needs a doctor’s attention.”

The Mayo Clinic advises you to call a primary care doctor if shortness of breath meets these criteria: (2)

• Is new to you
• Happens sooner or is worse than usual after exercise or other activities that you used to handle with ease
• Is accompanied by swelling in your feet and ankles, high fever, chills, wheezing, or cough
• Occurs or gets worse when you’re lying down (a symptom called orthopnea)

Varner stresses that you should call 911 or head to the emergency room if your shortness of breath progresses to one of these levels:

• Is persistent while sitting or at rest
• Is severe enough to interfere with daily living or function
• Is paired with chest pain or pain that spreads to your arms, neck, jaw, or back; dizziness or confusion; or bluish lips or nails (all may be signs of a heart attack or pulmonary embolism)

Breathing difficulties, whether mild or severe, can be traced to conditions that cause abnormalities or blockages in the lungs or in your airways, which include the following, per the National Heart, Lung, and Blood Institute (NHBLI): (3)

• Your mouth
• Your nose and linked air passages, called nasal cavities and sinuses
• Your larynx, or voice box
• Your trachea, or windpipe
• Your bronchial tubes or bronchi, and their branches

There are five common underlying conditions, according to the online Merck Manual: (4)

• Asthma Asthma-related inflammation causes airways to spasm and narrow, making it harder to breathe deeply.
• COPD A hallmark of COPD, which includes chronic bronchitis and emphysema, is difficulty pushing air out of your lungs.
• Heart Failure or Heart Disease If the heart cannot pump enough blood through the body, too little oxygen reaches your tissues, which can affect breathing.
• Being Out of Shape When your muscles and heart are weakened by inactivity, it can make breathing more difficult.
• Pneumonia Whether it is caused by bacteria or a virus (such as the flu or a coronavirus), this type of lung infection can lead to inflammation of the respiratory airway, increased and thickened mucus, and ultimately, difficulty with air exchange in the lung air sacs (alveoli), setting off a variety of other respiratory and systemic problems.

There are many other medical conditions that can lead to breathing difficulties:

• Allergies Allergens like pollen, mold, and animal dander can trigger asthma symptoms that make it hard to take normal breaths, according to the Centers for Disease Control and Prevention. (5) In extreme cases, allergic reactions to, say, peanuts, bee stings, or certain medications can cause anaphylaxis, an immune system response that can block breathing due to swollen airways.
• Anemia The most common type of anemia is caused by a shortage of iron, according to Mayo Clinic experts. (6) This can make it harder to breathe because iron is needed to make hemoglobin, the protein that red blood cells use to carry oxygen through the body.
• Anxiety “Anxiety can sometimes lead to hyperventilation, which is breathing too quickly,” explains Dr. Maxfield. And it can cause difficulty taking a deep breath. “You’re breathing so quickly, you don’t relax enough to let the air out, so you can’t get a deep breath — which can make you panic and try even harder to take in air while forgetting to exhale,” he says.
• Cancer Tumors in the throat or lungs can cause blockages that make it hard to catch your breath or inhale deeply. Certain cancer treatments may also cause breathing problems, per Cancer Research UK. (7)
• Colds and the Flu Both types of viral infections can cause swelling in the nasal passageways that greatly reduces or even blocks airflow to the lungs. COVID-19, which is caused by a novel coronavirus (SARS-CoV-2) in the same family as the viruses that cause colds, can also cause shortness of breath, Maxfield says. However, that is a less common symptom of COVID-19 than fever, cough, and fatigue, he notes. When breathlessness does occur, it usually means that the disease has infected the lungs and can be taken as a sign to seek medical attention.
• Diabetes Shortness of breath can be a sign of diabetic ketoacidosis, a serious complication of diabetes that occurs when your body produces high levels of blood acids called ketones, according to the Mayo Clinic. (8)
• Obesity Extra fat on your neck or chest or across your abdomen can make it difficult to breathe deeply, resulting in a breathing disorder called obesity hypoventilation syndrome, per the NHBLI. (9)
• Pulmonary Embolism When these blood clots in the legs or another part of the body (called deep vein thrombosis) travel to the lungs, they can block an artery and reduce the amount of oxygen circulating throughout the body. (10)
• Sleep Apnea If you have sleep apnea, you may have difficulty breathing at night. Your breathing slows or stops for seconds at a time repeatedly throughout your sleep cycle. Because breathing restarts quickly, you may never know if it ever stopped. In extreme cases, however, sleep apnea can trigger severe shortness of breath that causes you to suddenly wake up gasping for air, according to the Journal of Cardiology. (11) The medical term for this is paroxysmal nocturnal dyspnea, which can also be a symptom of other conditions, including heart failure.
• Medications In rare cases, certain medications, such as beta-blockers or aspirin, may cause breathlessness if you have asthma, Maxfield notes.

Nonmedical situations may cause breathing difficulties, too:

• High Altitude Because there is less oxygen in the air at altitudes above 4,000 feet, people who live closer to sea level may feel uncomfortably winded and light-headed for several hours or days until they become acclimated.
• Poor Indoor or Outdoor Air Quality Inhaling air pollutants can irritate airways, setting off symptoms that may include shortness of breath and asthma episodes, according to the Respiratory Health Association. (12)
• Extreme Weather Conditions Exposure to unusual temperatures like high heat forces your body to use extra energy to maintain your normal body temperature. This, in turn, forces your body to work harder to breathe, reports Breathe: The Lung Association. (13)

The first thing your doctor will do, explains Maxfield, is take a medical history that will include the following questions:

• When did your breathing difficulties start, and was the onset abrupt or gradual?
• How long have your breathing difficulties lasted?
• Did anything trigger your breathing difficulties or worsen them, such as allergens, extreme temperatures, or lying down?
• Have you experienced other symptoms? For example, dyspnea coupled with swelling in the feet and legs might indicate heart failure; high fever would usually signal an infection; and chest pain could be cardiac related or associated with a blood clot in the lung.
• What medications are you taking, and do you have a history of smoking, high blood pressure, lung or heart conditions or disorders, or risk factors for pulmonary embolism, such as recent surgery or long-distance travel?

Next, he says, your doctor will perform a physical exam, observing your breathing patterns, listening to your lungs and heart, and looking for fluid retention and signs of swelling.

Your doctor may also do these tests:

• Draw blood to test for signs of biomarkers of underlying conditions like heart disease.
• Measure how much oxygen your blood is carrying with a painless sensor (pulse oximeter) placed on the fingertip. Too little oxygen can be a sign that the lungs are not functioning properly.
• Perform an electrocardiogram to check for signs of heart or lung disease; do other tests to measure lung function and air flow; or order a chest X-ray to look for evidence of a collapsed lung, pneumonia, and other lung and heart abnormalities.

The diagnosis and treatment of dyspnea is sometimes made more difficult by the presence of more than one underlying health problem, which can happen often in older people. (14)

If oxygen levels in your blood are low, shortness of breath may be treated with oxygen administered via a tube that sits under your nostrils. (4) In general, however, shortness of breath is a symptom of an underlying condition, so the best way to treat it is to take medications for that condition as prescribed and to follow any other doctor-approved plan for managing your symptoms.

In cases of advanced pneumonia, COVID-19, or other infections or lung diseases, a ventilator is sometimes necessary to breathe for the body when the lungs are failing. By blowing air, or air with extra oxygen, into the airways and then the lungs, the ventilator supports life, preserving the patient's energy and allows them more time to fight off the infection, according to the American Thoracic Society (ATS). (15)

If you have a chronic condition that affects the lungs, such as COPD, the ALA suggests that you ask your pulmonologist (a lung specialist) about pulmonary rehabilitation, a form of outpatient treatment aimed at strengthening your lungs and muscles to improve your breathing and your quality of life. (16)

RELATED: How Does Pulmonary Rehab Help People With COPD?

Alternative and Complementary Therapies

If you have breathing difficulties, you may wonder if there are any supplements, herbal remedies, or other nontraditional treatments that might help. Small studies suggest certain alternative therapies may improve symptoms:

• Yoga According to the ATS, some research indicates that yoga can improve quality of life in people with asthma and COPD by increasing lung function and making it easier to exercise longer and more strenuously before experiencing shortness of breath and fatigue. (17) It also helps relieve stress, a common asthma trigger, per the Cleveland Clinic. (18)
• Pursed Lip Breathing Simply practicing breathing in through your nose and breathing out at least twice as long through your mouth while puckering your lips (as if blowing on hot food) helps keep your airways open, according to the ALA. (19) Start by inhaling slowly to a count of two and exhaling slowly to a count of four. Increase your counts over time.
• Probiotics These living microorganisms that have health benefits “coat all of your mucus membranes, so if you’re inhaling anything you shouldn’t be, you’re going to have a good barrier to strengthen the mucus membranes against irritation,” explains Stephanie Gray, a doctor of nursing practice and co-owner of the Integrative Health and Hormone Clinic in Hiawatha, Iowa. In addition, research published in the journal Mediators of Inflammation suggests that taking probiotic supplements, particularly Lactobacillus, Bifidobacterium, and Saccharomyce, may reduce inflammation in the airways caused by allergic reactions, viral infections, and asthma. (20)
• Omega-3 Fatty Acids Regularly consuming this healthy type of polyunsaturated fat found naturally in fish, nuts, and seeds helps reduce inflammation at a cellular level, says Gray. The National Academy of Medicine sets the adequate intake of alpha-linolenic acid, a kind of omega-3, at 1.6 grams (g) per day for men and 1.1 g per day for women, but Gray recommends higher doses — 2 g to 4 g per day in supplement form — for treating shortness of breath. (21)

Prevention of Breathing Difficulties

There are many steps you can take to help you avoid breathing problems. To start:

Stop smoking or vaping, if you do. Inhaling tobacco smoke is the major cause of lung cancer and COPD, according to the National Cancer Institute's SmokeFree.gov website. Within two weeks of becoming tobacco-free, you could notice that you’re breathing easier. The cilia (the hairlike microscopic structures in your respiratory tract) will also begin coming back to life, boosting your ability to fight off colds and infections. (22)

Stay hydrated. “Taking in plenty of fluids helps keep the mucus in your respiratory system thin, so it can trap large particles that you breathe,” says Varner. This helps your lungs cleanse themselves.

Be active. “Like the rest of your body, vigorous activity gives your lungs a good workout, which helps expand their capacity,” Varner says.

Lose weight if your body mass index (BMI) is 30 or higher. Being significantly overweight or obese (BMI is a type of measure for these categories) forces your heart and lungs to work harder, which can make breathing more difficult and aggravate conditions like COPD that are linked to shortness of breath.

Minimize your exposure to smog. Check daily air pollution forecasts in your area at AirNow.gov. Keep windows closed and limit your time spent outdoors when levels are high. A study of more than 300,000 people published in the European Respiratory Journal linked exposure to outdoor air pollution with decreased lung function and an increased risk of developing COPD. (23)

Reduce pollutants in the home. These include secondhand smoke, bleach and chemicals in cleaning products, mold from standing water, burning wood, and scented candles, according to the ALA. (24) Gray also advises airing out freshly dry-cleaned clothes by hanging them in your garage for a few days before bringing them into your home and opening your windows for a little while on days when the air quality is good.

Overall, shortness of breath is one of the most common of all medical complaints. It accounted for more than 7 percent of visits to hospital emergency rooms and as many as 25 percent of office visits to general practitioners, according to a report in Deutsches Ärzteblatt International, the German Medical Association's international bilingual science journal. (14)

That number is certainly higher since the novel coronavirus (SARS-CoV-2) pandemic has driven more and more people to hospitals, says Maxfield. However, it’s important to recognize that “difficulty breathing can be caused by many things other than COVID,” says Dr. Nagrani.

As noted above, there are many reasons you may be experiencing shortness of breath. These are the most common medical conditions related to respiratory difficulties:

• Asthma
• COPD
• Heart failure or heart disease
• Pneumonia

Additionally, conditions such as allergies and anxiety are associated with breathing difficulties.

Favorite Orgs for Essential Info About Breathing Difficulties

American Lung Association
The ALA is considered the leading nonprofit for learning about lung disease prevention, as well as symptoms, causes, and treatments. Sign up for its free newsletter for the latest news about lung health (including COVID-19) and research, inspiring stories, and resources. If you're looking to quit smoking, the ALA’s Freedom From Smoking Plus feature can help you create a personal quit-smoking plan on your desktop, tablet, or smartphone.

American Thoracic Society

The ATS is a go-to resource for reliable patient information on topics ranging from asthma and breathlessness to rarer lung diseases, such as obesity hypoventilation syndrome, and other adult and pediatric respiratory diseases and disorders.

British Lung Foundation

One of our favorite features from the British Lung Association is its web community, where you can chat online 24 hours a day with people experiencing shortness of breath and other lung-related symptoms.

Favorite Site for Becoming a COPD Advocate

COPD Foundation

If you’re looking for a way to make a difference, consider joining the foundation’s COPD Action Center, which works with local, state, and federal policy makers to increase research funding, improve care delivery, protect access to treatments, and create policy that improves the lives of those with COPD. You can also enroll in the organization’s COPD Patient-Powered Research Network to stay up-to-date on clinical trials and share your experience and health information with researchers to help deepen their understanding of the disease.

Favorite Apps

The Breathing App uses fun interactive features to help guide you as you learn to breathe more deeply at your own pace. You can choose between watching a ball expand as you inhale and get smaller as you exhale, a clock that counts up on the inhale and down on the exhale, or if you like to breathe with your eyes closed, musical cues to match your preferred breathing pattern. Practicing deep breathing can help maintain and increase your lung capacity, so it’s easier to keep your lungs healthy and get your body the oxygen it needs. It reduces stress, too!

Medisafe is a free app that helps you manage any medications you take, including those to treat chronic conditions that may cause shortness of breath. It reminds you when to take each of your meds, alerts you to potential drug interactions, and notifies you when your prescriptions are running low. The information can also be shared with your healthcare team and pharmacy.