TürkçeShortness of breath is the sensation that breathing is insufficient or difficult and can be brought under control with appropriate treatment according to the underlying cause. Factors such as lung diseases, heart failure, anemia, and anxiety may lead to this condition. The treatment plan is based on correctly identifying the cause.
Respiratory diseases such as asthma, COPD, pneumonia, and bronchitis hold an important place among the causes of shortness of breath. In addition, heart valve diseases, rhythm disorders, and obesity may also reduce respiratory capacity. In acutely developing cases, emergency conditions such as pulmonary embolism should be evaluated.
Methods that help relieve shortness of breath include supportive practices along with treatment of the underlying disease. Regular and controlled breathing exercises, quitting smoking, maintaining an ideal weight, and being in a clean-air environment improve respiratory functions. Bronchodilator medications used upon a doctor’s recommendation may reduce symptoms.
The treatment of chronic shortness of breath requires a multidisciplinary approach, and long-term follow-up is important. Pulmonary rehabilitation programs, oxygen therapy, and the cardiological evaluation process improve the patient’s quality of life. Early diagnosis and regular monitoring play a decisive role in reducing the risk of complications.
What Is Shortness of Breath and Why Is It Felt?
To understand shortness of breath, it is first necessary to look at how our body creates this sensation. There is a highly sensitive control center in our brain that continuously monitors the oxygen and carbon dioxide levels in our blood. This center processes signals coming from the lungs, rib cage, and muscles second by second. If everything is functioning properly, you do not notice that you are breathing. However, when there is an imbalance in the system, the brain goes into alarm mode and sends the command, “You need to breathe more.” This command is the sensation of effort that you perceive as shortness of breath.
Our patients describe this condition in very different ways. Some feel as if an elephant is sitting on their chest, while others describe it as if a hand is around their throat. Some complain that no matter how deeply they breathe, their lungs do not fill. These different sensations actually provide us with clues about the source of the underlying problem. For example, narrowing in the airways creates more of a feeling of “tightness,” while a collapsed lung causes air hunger accompanied by a sudden and sharp “stabbing” sensation.
The most common types of shortness of breath sensation are as follows:
- Air hunger
- Feeling of tightness in the chest
- Feeling of suffocation
- Need for rapid and shallow breathing
- Difficulty breathing in
- Difficulty breathing out
What Causes Shortness of Breath and Which Systems Are Affected?
When shortness of breath is mentioned, the first organ that naturally comes to mind is the lungs. However, the body functions as a whole, and the respiratory system works closely together with the circulatory system. Therefore, a problem in the heart may also feel as if it originates in the lungs. From a general perspective, we can group the causes of shortness of breath under several main headings.
Causes related to the respiratory system are generally associated with damage to the airways, lung tissue, or the lung membrane. In diseases such as asthma and COPD, the airways narrow and it becomes difficult to expel the air inside. In infections such as pneumonia, the sacs where oxygen passes into the blood fill with inflammation. Among heart-related causes, heart failure generally comes to the forefront; when the heart cannot pump blood sufficiently, fluid accumulates in the lungs, making breathing difficult.
In addition, anemia, thyroid disorders, or even poor physical condition may cause shortness of breath. However, as a thoracic surgeon, my primary focus is on structural problems that need to be corrected mechanically rather than with medication.
The main conditions that cause shortness of breath are as follows:
- Asthma
- COPD
- Pneumonia
- Pulmonary embolism
- Heart failure
- Anemia
- Obesity
- Panic attack
- Lung cancer
- Collapsed lung
What Are the Causes of Shortness of Breath Related to Thoracic Surgery?
There are some types of shortness of breath for which medications, vapors, or sprays alone cannot provide a solution. This is because there is a physical obstruction, a mechanical disorder, or a mass that needs to be removed. This is where thoracic surgery comes into play. Our job is to eliminate the mechanical problem that prevents the lung from expanding comfortably.
Fluid accumulation between the lung membranes, known as pleural effusion, is a condition we encounter frequently. The lung works by inflating and deflating like a balloon within the rib cage. However, if fluid fills the space between the lung membrane and the chest wall, this fluid compresses the lung from the outside. The lung cannot find enough space to expand and contracts. The patient experiences this as progressively worsening shortness of breath. Draining this fluid, sometimes with a simple needle and sometimes with minimally invasive surgical methods, provides immediate relief for the patient.
Similarly, the collapsed lung condition known as “pneumothorax” is also a surgical emergency. When a small blister on the lung bursts or chest trauma occurs, air leaks from the lung and fills the chest cavity. This escaped air collapses the lung. In this situation, the air entering through the patient’s windpipe becomes ineffective. Treatment requires reinflating the lung with a drain placed in the chest cavity or through minimally invasive surgery.
Other conditions treated by thoracic surgery are as follows:
- Pleural effusion
- Pneumothorax
- Lung nodules
- Lung tumors
- Tracheal stenosis
- Diaphragm paralysis
- Chest wall deformities
Do Lung Nodules and Masses Cause Shortness of Breath?
One of the issues our patients worry about most is spots detected in the lungs, namely nodules. Small nodules that are usually seen incidentally on imaging generally do not cause shortness of breath if they are not located directly in the center of the airways. However, the situation changes if these nodules grow or become masses that compress the main airways.
Large masses reduce capacity by occupying the ventilated portion of the lung. Sometimes they block the airway and prevent any air from reaching that region. In such cases, surgically removing the mass is vital both for treating the disease and opening the airway. Today, with advances in technology, we can perform these operations without opening the rib cage from end to end, using minimally invasive methods called “videothoracoscopy” (VATS) or robotic surgery. Thanks to these operations performed through several small incisions, our patients experience much less pain and quickly return to their normal lives by performing breathing exercises more comfortably.
Why Does Tracheal Stenosis Cause Shortness of Breath?
The windpipe (trachea) is the main highway through which air is carried to the lungs. Any narrowing along this route disrupts the entire system. Particularly in patients who have remained in intensive care for a long period and have been connected to a ventilator, narrowing may develop in the windpipe due to the pressure caused by the tubes used. During the healing process, the body forms hard scar tissue in that area while trying to repair the damaged region, and this narrows the airway.
These patients usually produce a wheezing sound while breathing in and out and describe the condition as “feeling as if I am trying to breathe through a straw.” Unfortunately, this condition is frequently confused with asthma, and patients may mistakenly use asthma medications for a long time. However, the problem here is not chemical but entirely mechanical. Surgically removing the narrowed section and reconnecting the healthy ends relieves the patient from this “straw breathing” and restores the airway to the width of a highway.
Factors that may lead to tracheal stenosis are as follows:
- Long-term intubation
- History of tracheostomy
- Neck trauma
- Tumor compression
- Inflammatory diseases
Is a Surgical Solution Possible in Patients with COPD and Emphysema?
COPD and emphysema are generally known as diseases managed with lifelong medication and oxygen support. However, in a highly selected group of patients, it is possible to relieve shortness of breath with surgical intervention. We can compare an emphysematous lung to a balloon that has lost its elasticity and become excessively inflated. This balloon becomes so inflated that it completely fills the inside of the rib cage. At first, this may sound like a good thing, but in fact this swelling is a “damaged” swelling. The stale air trapped in the lung cannot escape, leaving no room for fresh oxygen. In addition, these excessively inflated lungs push the diaphragm, the main muscle of breathing, downward, flattening it and preventing it from functioning.
In the method we call “Lung Volume Reduction Surgery,” we remove the most damaged, nonfunctional, and ballooned portions of the lung. This may sound contradictory; why remove part of the lung from someone who already cannot breathe? The logic is as follows: When we remove those damaged areas that do not function and merely occupy space, the healthier tissues that remain find room to expand. Most importantly, the pressure on the diaphragm is relieved, and the diaphragm begins to perform its strong pumping function again. This surgery significantly reduces shortness of breath in suitable patients.
Do Chest Shape Deformities Cause Shortness of Breath?
The condition commonly known as “funnel chest,” in which the breastbone is sunken inward (pectus excavatum), is generally perceived as only a cosmetic concern. Young people, especially during adolescence, consult us because they are uncomfortable with their appearance. However, when we examine them and take their imaging studies, we see that the issue is not only external appearance.
The breastbone that is sunken inward presses on the heart and right lung directly behind it. The heart, which should normally fill and empty comfortably, cannot function at full capacity under this pressure. The patient may not notice this while at rest, but when climbing stairs, running, or exercising, they become tired, feel restricted, and become out of breath much more quickly than their peers. With the minimally invasive surgical method called the “Nuss procedure,” we correct this depression using a metal bar placed beneath the rib cage. When the rib cage regains its normal width, the pressure on the heart and lungs is relieved, and the patient’s exercise capacity increases significantly.
Do Diaphragm Problems Cause Shortness of Breath?
The diaphragm is a parachute-shaped, very powerful muscle that separates the chest cavity from the abdominal cavity. Even though we are not aware of it, this muscle alone performs eighty percent of the work of breathing. When the diaphragm contracts, it moves downward and the lungs fill with air. However, the diaphragm may sometimes become paralyzed or weaken and rise upward due to nerve damage, trauma, or viral infections.
When the diaphragm rises upward (eventration), the stomach and intestines beneath it also move upward with it toward the chest cavity. This compresses the lung from below. The space where the lung should expand and fill with air is occupied by the intestines. These patients experience a feeling of suffocation, especially when lying on their back, because the weight of the abdominal organs presses even more heavily on the lung. When we surgically tighten the diaphragm and secure it downward in its proper position (plication), the lung is freed again and respiratory capacity is restored.
What Helps Shortness of Breath at Home?
In addition to medical treatments, there are some simple but effective methods that you can apply at home when experiencing shortness of breath or coping with chronic shortness of breath. These methods do not treat the disease, but they may relieve symptoms and improve your quality of life.
First of all, I cannot proceed without mentioning smoking. Quitting smoking is the greatest favor you can do for your lungs, and no medication or surgery can completely reverse the damage caused by smoking. Apart from this, the most important rule is not to panic when you feel short of breath. Panic accelerates your breathing and makes the situation even worse.
Methods that can be applied at home to relieve shortness of breath are as follows:
- Fan
- Cool mist
- Pursed-lip breathing
- Diaphragmatic breathing
- Forward-leaning position
- Sitting upright
- Coffee
- Fresh ginger tea
- Fresh air
I would like to explain the “Pursed-Lip Breathing” technique in a little more detail. This is especially valuable for patients with COPD. Take a calm breath through your nose. Then purse your lips as if you are going to whistle and exhale very slowly through your mouth over a long period. This method creates pressure inside your airways, preventing them from closing prematurely and helping to release the stale air trapped inside.
The use of a “fan” may also sound interesting, but it has a scientific basis. A gentle stream of cool air directed toward your face, for example with a handheld fan, stimulates the nerves in the face and sends the signal “air is coming” to the brain, which may reduce the perception of shortness of breath.
How Is Shortness of Breath Diagnosed?
An accurate diagnosis is essential for proper treatment. In a patient who comes to the outpatient clinic, we first perform a careful listening examination (auscultation). Lung sounds tell us a great deal about whether there is fluid inside, whether the airways have narrowed, or whether an infection is present. However, with today’s technology, we do not rely only on a stethoscope.
Although chest X-ray is the first step, Computed Tomography (CT) is our map. With CT, we can see the finest details of the lung, millimetric nodules, and the structure of the airways. If we suspect a problem inside the airways, we perform “Bronchoscopy.” This allows us to enter through the windpipe with a thin, flexible tube with a camera at the tip and view the inside of the lungs live on a screen. If necessary, we take a tissue sample from there. If the problem is outside the lung, between the membranes, then with the minimally invasive methods I mentioned earlier (thoracoscopy), we can both diagnose and treat it at the same time.
The methods used during the diagnostic stage are as follows:
- Physical examination
- Chest X-ray
- Computed tomography
- Pulmonary function test
- Bronchoscopy
- Blood gas analysis
- Echocardiography
When Should You See a Doctor and Is Shortness of Breath Dangerous?
Shortness of breath is not always a condition that can be dismissed by saying, “I will rest for a while and it will pass.” Sometimes it may be a warning sign of a life-threatening crisis that requires intervention within minutes. If you have had shortness of breath for years and it has gradually worsened, this is a chronic process, but you still need to see a doctor. However, if the condition developed suddenly, it means your body is sounding an emergency alarm.
Symptoms requiring emergency medical assistance are as follows:
- Shortness of breath continuing at rest
- Bluish discoloration of the lips
- Bluish discoloration of the fingertips
- Confusion
- Difficulty speaking
- Severe chest pain
- Bloody sputum
- Wheezing
- High fever
- Feeling faint
If even one of these symptoms is present, looking for a solution at home is a waste of time. Bluish discoloration of the lips and confusion, in particular, are the clearest signs that the body is being deprived of oxygen and that the brain has begun to be affected.
Frequently Asked Questions
Prof. Dr. Alper Fındıkcıoğlu graduated from Istanbul University Faculty of Medicine and completed his thoracic surgery residency at Dr. Siyami Ersek Hospital. He began his academic career at Başkent University in 2005; he received the title of associate professor in 2014 and professor in 2022. He has extensive experience in lung cancer, chest wall diseases, and minimally invasive surgery. Since 2024, he has been continuing his professional work at Acıbadem Hospital.
