Breathlessness

Man suffering from breathlessness

What is Breathlessness (Dyspnoea)?

If there is one thing that most of us are familiar with, it’s breathlessness: commonly and normally experienced during strenuous exercise. But when breathlessness happens out of the blue when we are at rest, it can be frightening and worrisome. 

Breathlessness, also known as shortness of breath, or dyspnoea, is often described as air hunger, difficulty to breathe, or even suffocation1. It can be characterised by chest tightness and chest pains when breathing. While breathlessness during strenuous exercise or in extreme altitudes is normal in healthy people, breathlessness or feeling out of breath unexpectedly or suddenly while you are at rest or not doing anything strenuous, is often a sign of a medical condition.

Breathlessness can be catergorised into 2 groups, these are:

  • Short-term (acute) or sudden breathlessness
  • Long-term (chronic) or prolonged breathlessness

What are the common causes of Breathlessness in Singapore?

The causes of short-term breathlessness are1,2:

  • Asthma: a respiratory condition that affects the lower respiratory tract3.
  • Anxiety: often causes hyperventilation or rapid breathing4.
  • Heart attack: blockage of blood flow to the heart can cause breathlessness5.
  • Pulmonary embolism: blood clot in your lungs6.
  • Infections: bronchitis, COVID-19, or pneumonia are lung infections that may cause excess mucus to be produced which can block or narrow airways, resulting in breathlessness7.
  • Anaphylaxis: severe allergic reaction which causes your airways to swell making it hard to breathe8.
  • Pneumothorax: collapsed lungs will cause breathlessness9.
  • Chronic obstructive pulmonary disease (COPD): when symptoms of COPD worsen, breathlessness can occur10.

Acute or short-term breathlessness usually disappear after a week or so, chronic breathlessness is prolonged and may last more than a month.

The causes of long-term breathlessness are:

  • Interstitial lung disease (ILD): scarring of the lungs11.
  • Pleural effusion: build-up of fluid around the lungs12.
  • Cardiac dysfunction: heart disease or malfunction13,14.
  • Anaemia: lack of red blood cells which causes inadequate oxygen to be transported around the body14.
  • Deconditioning: changes in the body that occur due to inactivity14.
  • Tuberculosis: life-threatening bacterial infection that can cause prolonged breathlessness15.

What are the symptoms of Breathlessness?

As its name suggests, breathlessness is feeling breathless or short of breath. It is the feeling of not being able to catch your breath no matter how hard or much you breathe. 

Some breathlessness after strenuous activity is to be expected, however, if you are feeling breathless all of a sudden or while doing activities which normally do not tire you, then it could be something serious.

Is Breathlessness painful?

In some people, breathlessness can also be accompanied by chest tightening and chest pains.

Who is at risk of Breathlessness in Singapore?

Other than the previously mentioned causes of short-term and long-term breathlessness, there are certain factors that could increase your risk of breathlessness, these are:

  • Smoking: if you smoke or have a history of smoking, you could have an increased risk of breathlessness.
  • Poor fitness: if you have not been physically active for a while, you may experience breathlessness while doing physical activities.
  • Obesity: obesity has long been associated with breathlessness and other respiratory conditions.

How is Breathlessness diagnosed in Singapore?

After explaining your medical history and having a physical examination, you may be subjected to the following diagnostic tests:

  • Pulse oximetry: finger sensor that examines how much oxygen is present in your blood.
  • Chest x-ray or computed tomography scans (CT-scan): to check for the cause of your breathlessness.
  • Blood tests: to check for infections or anaemia.
  • Lung function tests: such as spirometry or peak flow test to check how well your lungs are functioning.

What are the treatment options for Breathlessness in Singapore?

Treatment for breathlessness varies as it must be aimed at the main underlying cause of it. However, a general way to prevent or reduce breathlessness is to stop smoking or be in a smoke-free environment. Depending on the underlying cause of breathlessness, the follow treatment options are available:

  • Bronchodilators
  • Steroids
  • Painkillers 
  • Surgery

Relaxation and breathing exercises can also be used to alleviate the symptoms of breathlessness.

Frequently asked questions

How do I know if my breathlessness is serious?

All sudden and unexpected cases of breathlessness should be taken seriously, particularly if it is accompanied by bluish fingertips or lips, chest pains, nausea, mental fogginess, etc.

What should I do if I feel breathless?

If your breathlessness goes away after a while, monitor it, and note down when it occurs or what makes it worse, make an appointment to see a respiratory specialist to check if everything is alright. If your breathlessness is accompanied by other symptoms such as chest pains and other serious symptoms (like those stated above), go to the A&E.

References

  1. Mayo Clinic Staff. (2020, June 13). Shortness of Breath. Retrieved from Mayo Clinic: https://www.mayoclinic.org/symptoms/shortness-of-breath/basics/definition/sym-20050890 
  2. Cleveland Clinic Professional. (2019, December 20). Shortness of Breath (Dyspnea). Retrieved from Mayo Clinic: https://my.clevelandclinic.org/health/symptoms/16942-shortness-of-breath-dyspnea 
  3. Giorgio Scano, L. S. (2006). Dyspnea and asthma. Current Opinion in Pulmonary Medicine, 18-22.
  4. Giorgio Scano, F. G. (2013). Dyspnea and emotional states in health and disease. Respiratory Medicine, 649-655.
  5. Joseph P Ornato, M. M. (2014). Warning signs of a heart attack. Circulation.
  6. Øyvind Jervan1, J. G. (2021). Pulmonary and cardiac variables associated with persistent dyspnea after pulmonary embolism. Thrombosis Research, 90-99.
  7. Robinson, P. (2021). Long COVID and breathlessness: an overview. British Journal of Community Nursing, 438-443.
  8. Brown, S. G. (2004). Clinical features and severity grading of anaphylaxis. The Journal of Allergy and Clinical Immunology, 371-376.
  9. Hiroyuki Yamamoto, K. S. (2021). Electrocardiographic manifestations in a large right-sided pneumothorax. BMC Pulmonary Medicine.
  10. Denis E O'Donnell, K. M. (2020). Dyspnea in COPD: New Mechanistic Insights and Management Implications. Advances in Therapy, 41-60.
  11. Leona Dowman, C. J. (2021). Pulmonary rehabilitation for interstitial lung disease. Cochrane Database Systematic Reviews.
  12. Rajesh Thomas, M. A. (2016). Protocol of the PLeural Effusion And Symptom Evaluation (PLEASE) study on the pathophysiology of breathlessness in patients with symptomatic pleural effusions . BMJ Open.
  13. Gerard A Silvestri, D. A. (1993). Evaluation of dyspnea in the elderly patient. Clinics in Chest Medicine, 393-404.
  14. Mahler, D. A. (2017). Evaluation of dyspnea in the elderly. Clinics in Geriatric Medicine, 503-521.
  15. Laneke Luies, I. d. (2020). The Echo of Pulmonary Tuberculosis: Mechanisms of Clinical Symptoms and Other Disease-Induced Systemic Complications. Clinical Microbiology Reviews.
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