Update: December 2018
Shortness of breath – a feeling of lack of air, in connection with which there is
the need to strengthen the breath. This is one of the most frequent complaints.
patients during a visit to a general practitioner or
It is a common symptom of various diseases.
organs and systems of the human body – respiratory,
cardiovascular, endocrine, nervous.
Shortness of breath accompanies:
- infectious diseases
- various kinds of intoxication
- neuromuscular inflammatory processes
- but it may occur in quite healthy people with overweight
with the detraining of the body – sedentary lifestyle,
- in individuals with labile nervous system as psycho-emotional
- with metabolic disorders, blood diseases,
This symptom can be as pathological compensatory, so
and physiological character, and its severity is often not
corresponds to the degree of pathological disorders in the body.
Multi-factorial and low specificity in many cases
make it difficult to use for the diagnosis or assessment of severity
specific disease. However, detailed and multistage
examination of the patient to determine the cause of shortness of breath is
What is shortness of breath?
Shortness of breath, or dyspnea (breathing disorder) may be accompanied
objective respiratory disorders (depth, frequency, rhythm)
or just subjective sensations.
According to the definition of academician Votchala B.E., shortness of breath – is in
first of all the patient’s sensation forcing him to limit
exercise or increase breathing.
If breathing problems do not cause any sensations, then this
the term is not used, and we can talk only about the assessment
nature of the violation, that is, breathing difficult, superficial,
irregular, excessively deep, amplified. However, the suffering and
the patient’s psychological response is not less
Currently, the definition of the concept of dyspnea,
proposed by the Thoracic (Thoracic) Society of the United States. In accordance with
him shortness of breath is a reflection of the patient’s subjective perception
respiratory discomfort and includes a variety of quality
sensations varying in intensity. Its development can cause
secondary physiological and behavioral reactions and being
due to the interaction of psychological, physiological,
social and environmental factors. The following degrees are distinguished.
shortness of breath:
|No shortness of breath||Dyspnea on exertion occurs only with severe physical
stress (sports, weightlifting up the stairs,
jogging, long swimming), then breathing quickly
|Mild dyspnea||The occurrence of shortness of breath when walking fast, a long climb on
stairs or uphill
|Average||Due to difficulty breathing a person is forced to walk more
slowly, sometimes making stops while walking to
catch my breath
|Heavy||When walking the patient stops every few minutes, then
there is no more than 100 meters and stops in order to
|Very heavy||Dyspnea occurs even at rest or at the slightest movement or when
exercise, the patient usually does not leave the house
A more complete picture of dyspnea is demonstrated by the following
- The normal number of breaths in a healthy person in a calm
condition is 14 – 20 in 1 minute.
- A person who is unconscious due to any
diseases, it can be non-rhythmic, exceed the norm in frequency
or be much less common. This condition is regarded as
respiratory failure, but not called shortness of breath.
- Dyspnea is considered such a condition (which is not amenable
the measurement of any methods) – the presence of patient complaints
feeling of lack of air at normal rates of frequency
breathing and rhythm, and shortness of breath occurs only with increasing depth
acts of breath.
Thus, the accepted definition, as well as the definition
Academician Votchala BE, treats this symptom as
psychological subjective perception, physiological awareness
or pathological stimuli and changes in the body.
A person describes shortness of breath, like pain, with a variety of colorful
- choking sensation
- lack of air
- a feeling of chest fullness
- feeling of lack of air filling the lungs
- �”Fatigue in the chest”
Dyspnea can be both physiological, “safe” – normal.
reaction of the organism, and pathological, because it is one
from the symptoms of a number of diseases:
Physiological changes in respiration that quickly come to
- while running, sports exercises in the gym,
swimming in the pool
- quick climb stairs
- when doing heavy physical exertion
- with a pronounced emotional reaction in a healthy body
(experience, stress, fear)
Pathological reactions occurring in diseases
Dyspnea on exertion occurs even when its intensity is weak,
slight voltage. Cause dyspnea when walking
is a disease of the lungs, heart, anemia, diseases
endocrine system, nervous system, etc.
see new research scientists on the effect of heart load.
Symptom Formation Mechanisms
Unfortunately, very often many doctors have a mechanism of occurrence and
development of dyspnea is associated only with:
- obstruction (obstruction) of the airways at a distance
from vocal cords in larynx to alveoli
- with heart failure leading to stagnation in
Based on these (often erroneous) conclusions
plan further instrumental and laboratory diagnostic
examinations and treatment.
However, the pathogenesis of dyspnea is much more complicated, and its causes are significantly
more. There are many assumptions about the development of dyspnea. Most
convincing theory is based on perceptions and
brain analysis of impulses entering it as a result
discrepancies in tension and tension of the respiratory muscles.
The degree of irritation of the nerve endings that control
muscle tension and transmit signals to the brain without
corresponds to the length of these muscles. It is assumed that such
discrepancy and is the cause of human perception that
breathing is too small compared to the voltage of the group
respiratory muscles. Pulses from the nerve endings of the respiratory tract
or lung tissue through the vagus nerve enter the
central nervous system and form conscious or
subconscious feeling of breathing discomfort, that is, feeling
shortness of breath.
The described scheme gives a general idea of the formation of dyspnea.
It is suitable only for partial justification, for example, the reasons
одышки when walking или других физических нагрузках, так как в данном
chemoreceptor irritation is
concentration of carbon dioxide in the blood.
A large number of causes and variants of pathogenesis is due to
a variety of physiological processes and anatomical structural
units providing normal breathing. Always prevails
or another mechanism, depending on the situation that his
provoked. For example, it may occur with irritation.
receptors of the larynx or trachea, medium and small bronchi,
respiratory muscles, all at the same time, etc. However, the principles
implementation and mechanisms of dyspnea at different
The circumstances are the same.
So, shortness of breath is characterized by an awareness of excessive activation.
brain pulses from the respiratory center in the medulla
the brain. It, in turn, is brought into active state.
ascending signals due to irritation
peripheral receptors in various structures of the body and
transmitted by conductive nerve pathways. The stronger
irritants and dysfunction of breathing, the more difficult the shortness of breath.
Pathological impulses can come from:
- The centers themselves in the cerebral cortex.
- Baroreceptors and mechanoreceptors of the respiratory muscles and
other muscles or joints.
- Chemoreceptors responsive to changes in concentration
carbon dioxide and located in the carotid bodies of the carotid arteries,
aorta, brain and other parts of the circulatory system.
- Receptors that respond to changes in acid-base
- Intra Thoracic Vagal and Phrenic Endings
Prove the presence of shortness of breath and establish its causes help, in
some degree, additional methods instrumental and
laboratory research. These are:
- special questionnaires with a multipoint system of answers to
- spirometry, by which volumes and speeds are measured
inhalation and exhalation of air;
- pneumotachography, which allows you to register volumetric
airflow speed during calm and
- testing using dosed physical
loads on a bicycle ergometer or treadmill;
- carrying out tests with the drugs causing narrowing
- determination of blood oxygen saturation with a simple
pulse oximeter device;
- laboratory study of gas composition and acid-base
blood conditions, etc.
Clinical classification of shortness of breath
In practical medicine, despite the non-specificity of dyspnea, it
still treated in conjunction with other symptoms as
diagnostic and prognostic sign for different
pathological conditions and processes. There are many
classifications of variants of this symptom, indicating a connection with
a certain group of diseases. In many pathological conditions by major
to indicators, it has a mixed developmental mechanism. In practical
dyspnea is divided into four main types:
Dyspnea central genesis – with neurology or tumors
It differs from all others in that it itself is the cause
disturbances of gas exchange processes, while other types of dyspnea
result from already disturbed gas exchange and carry
compensatory character. Gas exchange with central dyspnea
disrupted due to pathological depth of breathing, frequency or rhythm,
not adequate metabolic needs. Such central
violations may occur:
- as a result of drug overdoses or sleeping pills
- при опухолях спинного или головного brain
- pronounced psycho-emotional and depressive states
In psychoneurotic disorders, complaints of shortness of breath
usually 75% of patients undergoing treatment at the clinic
neurotic states and pseudoneuroses, these are people
stress-responsive, very easily excitable, hypochondriacs.
The peculiarity of psychogenic respiratory disorders is considered to be its noise
accompaniment – frequent moaning, heavy sighs, groans.
- such people experience persistent or periodic feeling
lack of air, the presence of barriers in the larynx or in the upper
parts of the chest
- the need for additional inspiration and the impossibility of it
exercise “respiratory corset”
- try to open all the doors and windows or run out into the street “on
- such patients feel pain in the heart area in the absence of
pathologies are sure they have heart failure and
experiencing the fear of dying from choking with indifference to the presence of others
These violations are accompanied by an unreasonable increase in the frequency
or depths of breathing that do not give relief,
inability to hold your breath. Sometimes there are false attacks.
bronchial asthma or laryngeal stenosis after any experiences
or conflicts, even experienced doctors resulting in
Central dyspnea may manifest itself in various
Tachiponoe – a sharp increase in the frequency of breathing to 40 – 80 or more
in 1 minute, which leads to a decrease in carbon dioxide content in
blood and as a result:
- to weakness
- lower blood pressure (see norm)
- loss of consciousness
Tachypnea может возникать при тромбоэмболии легочной артерии,
пневмонии, перитоните, остром холецистите, neurosis, особенно при
hysteria, muscle pain in the chest, high fever,
flatulence and other conditions.
Deep, but rare, less than 12 in 1 minute, breathing, which
occurs when there is difficulty transporting air through the upper
Airways. This variant of dyspnea occurs:
- when using drugs
- опухолях brain
- Pickwick syndrome
when breathing in a dream is accompanied by stopping up to 10 or more
seconds, then with full awakening comes tachypnea.
Disturbance of a rhythm of breath on amplitude and frequency.
- It occurs, for example, in aortic valve insufficiency,
when the contraction of the left ventricle of the heart is in the aortic arch, which means
and the brain enters an increased blood volume, and when relaxed
ventricle there is a sharp reverse blood outflow due to lack of
obstruction, that is, the presence of a deformed aortic valve.
- This is especially pronounced with the psycho-emotional stress that
causes “respiratory panic” and the fear of death.
Shortness of breath in heart failure
One of the main symptoms of heart disease is shortness of breath.
The most common cause is high pressure in the vessels of the heart.
Initially (early stages) patients with heart failure
feel like a “lack of air” only when physical
load, as the disease progresses, dyspnea begins
disturb and with a slight load, and then at rest.
Shortness of breath in heart failure имеет смешанный механизм, в
where respiratory stimulation is of paramount importance.
center in the medulla oblongata with impulses from volumes and baroreceptors
vascular bed. They, in turn, are caused mainly
circulatory failure and blood stasis in the pulmonary veins,
increase blood pressure in the pulmonary circulation. It has
value and violation of diffusion of gases in the lungs, violation
elasticity and flexibility of stretching the lung tissue, reducing
excitability of the respiratory center.
Shortness of breath in heart failure носит характер:
when an increase in gas exchange is achieved due to a deeper
and frequent breathing at the same time. These options are in
depending on the increasing load on the left heart and small
circle of blood circulation (in the lungs). Polypnea при заболеваниях сердца
provoked mostly even a slight exertion
(climbing stairs) may occur at high temperatures
pregnancy, when changing the vertical position of the body on
horizontal, with the bends of the body, violations of the heart
This is a condition in which the patient is forced to be (even
sleep) upright. This leads to an outflow of blood to
legs and lower torso, unloading small circle
blood circulation and leading to easier breathing.
Night paroxysm of dyspnea, or cardiac asthma, which
представляет собой развитие отека lungs. Shortness of breath accompanied
choking, dry or wet (with frothy sputum) cough,
weakness, sweating, fear of death.
It is provoked by a violation of the respiratory mechanics of bronchitis,
pneumonia, bronchial asthma, dysfunction aperture
significant spinal curvature (kyphoscoliosis). Pulmonary
dyspnea variant is divided into:
Inspiratory shortness of breath – difficulty breathing
In this variant of breathlessness, all
auxiliary muscles. It arises:
- with difficulty breathing in case of lung tissue loss
elasticity in pneumosclerosis, fibrosis, pleurisy,
common pulmonary tuberculosis, lung cancer
- rough pleural layers and carcinomatosis
- high standing of the diaphragm due to pregnancy
- paralysis of the phrenic nerve in ankylosing spondylitis
- in patients with bronchial asthma with narrowing of the bronchi as a result
pneumothorax or pleurisy
- inspiratory dyspnea may be caused by a foreign body in
- laryngeal tumor
- swelling of the vocal cords during laryngeal stenosis (often in children under 1
years, see barking cough in a child and treatment of laryngitis in children)
Expiratory dyspnea – exhalation difficulty
It is characterized by difficulty exhaling due to changes in the walls.
bronchial or spasm due to inflammatory or allergic
swelling of the mucous membrane of the bronchial tree, sputum accumulations.
Most часто она встречается при:
- bouts of bronchial asthma
- chronic obstructive bronchitis
Such shortness of breath also occurs with the participation of not only respiratory,
but also auxiliary muscles, although less pronounced than in
With lung diseases in advanced stages, as well as
heart failure, shortness of breath can be mixed, that is, and
expiratory and inspiratory when it is hard to both inhale and
Hematogenous type of dyspnea
This species is most rare in comparison with previous
variants, and is characterized by high frequency and depth of breathing.
It is associated with changes in blood PH and toxic effects.
metabolic products, in particular urea, to the respiratory center.
Most часто эта патология встречается при:
- endocrine disorders – severe forms of diabetes,
- liver and kidney failure
- with anemia
In most cases, shortness of breath is mixed.
Approximately 20% of its cause, despite detailed examination
patients remains unidentified.
Shortness of breath with endocrine diseases
People with diabetes, obesity, thyrotoxicosis in
most cases also suffer from shortness of breath, the reasons for its occurrence
with endocrine disorders the following:
- With diabetes mellitus with time necessarily occur
changes in the cardiovascular system when all organs are affected
from oxygen starvation. Moreover, sooner or later with diabetes
renal function is disturbed (diabetic nephropathy), occurs
anemia, which further aggravates hypoxia and increases
shortness of breath.
- Obesity – it is obvious that with an excess of adipose tissue, such
organs like the heart, the lungs are subject to increased stress, which is also
complicates the function of the respiratory muscles, causing shortness of breath with
walking, under load.
- При thyrotoxicosis, когда выработка гормонов щитовидной железы
excessive, all metabolic processes increase sharply, which increases and
oxygen demand. Moreover, when hormones are in excess
quantity, they increase the number of heartbeats, while
the heart cannot fully supply all organs with blood (oxygen)
and tissues, hence the body tries to compensate for this hypoxia – how
a consequence of shortness of breath.
Одышка with anemia
Animi is a group of the pathological state of the organism, with
which changes the composition of the blood, decreases the number of red blood cells and
hemoglobin (with frequent bleeding, blood cancer, in vegetarians,
after severe infectious diseases, with cancer
processes, congenital metabolic disorders). Via
hemoglobin in the body is the delivery of oxygen from the lungs
in tissue, respectively, with its lack of organs and tissues
experiencing hypoxia. Increasing the body’s oxygen demand
trying to compensate for the increase and deepening of breaths –
shortness of breath occurs. Кроме одышки with anemia пациент чувствует
dizziness (causes), weakness, worsening of sleep, appetite,
For the doctor is extremely important:
- determining the cause of shortness of breath during exercise or
- understanding and correct interpretation of the patient’s complaints;
- clarifying the circumstances under which this arises
- the presence of other symptoms that accompany shortness of breath.
No less important is:
- general idea of the patient about dyspnea itself;
- his understanding of the mechanism of dyspnea;
- timely visit a doctor;
- correct description of the patient’s feelings.
Thus, dyspnea is a symptom complex inherent in
physiological and many pathological conditions. Survey
patients should be individualized using all available
techniques to objectify it in order to select the most
rational treatment method.