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Classification and external resources
Specialty Pulmonology
ICD-10 R06.0
ICD-9-CM 786.09
DiseasesDB 15892
MedlinePlus 003075
Patient UK Dyspnea
MeSH D004417

Dyspnea, dyspnoea, shortness of breath or breathlessness is the feeling or feelings associated with impaired breathing. The American Thoracic Society defines it as "a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity," and recommends evaluating dyspnea by assessing the intensity of the distinct sensations, the degree of distress involved, and its burden or impact on activities of daily living. Distinct sensations include effort/work, chest tightness, and air hunger (the feeling of not enough oxygen).[1]

Dyspnea is a normal symptom of heavy exertion but becomes pathological if it occurs in unexpected situations.[2] In 85% of cases it is due to asthma, pneumonia, cardiac ischemia, interstitial lung disease, congestive heart failure, chronic obstructive pulmonary disease, or psychogenic causes,[2][3] such as panic disorder and anxiety.[4] Treatment typically depends on the underlying cause.[5]



Differential diagnosis[edit]


Acute coronary syndrome[edit]

Acute coronary syndrome frequently presents with retrosternal chest discomfort and difficulty catching the breath.[2] It however may atypically present with shortness of breath alone.[13] Risk factors include old age, smoking, hypertension, hyperlipidemia, and diabetes.[13] An electrocardiogram and cardiac enzymes are important both for diagnosis and directing treatment.[13] Treatment involves measures to decrease the oxygen requirement of the heart and efforts to increase blood flow.[2]

Congestive heart failure[edit]

Congestive heart failure frequently presents with shortness of breath with exertion, orthopnea, and paroxysmal nocturnal dyspnea.[2] It affects between 1–2% of the general United States population and occurs in 10% of those over 65 years old.[2][13] Risk factors for acute decompensation include high dietary salt intake, medication noncompliance, cardiac ischemia, dysrhythmias, renal failure, pulmonary emboli, hypertension, and infections.[13] Treatment efforts are directed towards decreasing lung congestion.[2]

Chronic obstructive pulmonary disease[edit]



Asthma is the most common reason for presenting to the emergency room with shortness of breath.[2] It is the most common lung disease in both developing and developed countries affecting about 5% of the population.[2] Other symptoms include wheezing, tightness in the chest, and a non productive cough.[2] Inhaled corticosteroids are the preferred treatment for children, however these drugs can reduce the growth rate.[14] Acute symptoms are treated with short-acting bronchodilators.


Main article: Pneumothorax



Main article: Pneumonia

The symptoms of pneumonia are fever, productive cough, shortness of breath, and pleuritic chest pain.[2] Inspiratory crackles may be heard on exam.[2] A chest x-ray can be useful to differentiate pneumonia from congestive heart failure.[2] As the cause is usually a bacterial infection, antibiotics are typically used for treatment.[2]

Severity and prognosis of pneumonia can be estimated from CURB65, where C=Confusion, U= Uremia (>7), R=Respiratory rate >30, B= BP<90, 65= Age>65.[citation needed]

Pulmonary embolism[edit]

Pulmonary embolism classically presents with an acute onset of shortness of breath.[2] Other presenting symptoms include pleuritic chest pain, cough, hemoptysis, and fever.[2] Risk factors include deep vein thrombosis, recent surgery, cancer, and previous thromboembolism.[2] It must always be considered in those with acute onset of shortness of breath owing to its high risk of mortality.[2] Diagnosis however may be difficult[2] and Wells Score is often used to assess the clinical probability. Treatment, depending on severity of symptoms typically start with anticoagulants, presence of ominous signs (low blood pressure), may warrant the use of thrombolytic drugs.[2]


Anaemia that develops gradually usually presents with exertional dyspnea, fatigue, weakness, and tachycardia.[15] It may lead to heart failure.[15] Anaemia caused by low hemoglobin levels is often a cause of dyspnea. Menstruation, particularly if excessive, can contribute to anaemia and to consequential dyspnea in women. Headaches are also a symptom of dyspnea in patients suffering from anaemia. Some patients report a numb sensation in their head, and others have reported blurred vision caused by hypotension behind the eye due to a lack of oxygen and pressure; these patients have also reported severe head pains, many of which lead to permanent brain damage. Symptoms of this can be loss of concentration, focus, fatigue, language faculty impairment and memory loss.[citation needed]


Other important or common causes of shortness of breath include cardiac tamponade, anaphylaxis, interstitial lung disease, panic attacks,[5][11][15] and pulmonary hypertension. Cardiac tamponade presents with dyspnea, tachycardia, elevated jugular venous pressure, and pulsus paradoxus.[15] The gold standard for diagnosis is ultrasound.[15] Anaphylaxis typically begins over a few minutes in a person with a previous history of the same.[5] Other symptoms include urticaria, throat swelling, and gastrointestinal upset.[5] The primary treatment is epinephrine.[5] Interstitial lung disease presents with gradual onset of shortness of breath typically with a history of a predisposing environmental exposure.[11] Shortness of breath is often the only symptom in those with tachydysrhythmias.[13] Panic attacks typically present with hyperventilation, sweating, and numbness.[5] They are however a diagnosis of exclusion.[11] Around 2/3 of women experience shortness of breath as a part of a normal pregnancy.[8] Neurological conditions such as spinal cord injury, phrenic nerve injuries, Guillain-Barre syndrome, amyotrophic lateral sclerosis, multiple sclerosis and muscular dystrophy can all cause an individual to experience shortness of breath.[10] Another condition involving shortness of breath is empty nose syndrome.


Different physiological pathways may lead to shortness of breath including via ASIC chemoreceptors, mechanoreceptors, and lung receptors.[13]






mMRC breathlessness scale
Grade Degree of dyspnea
0 no dyspnea except with strenuous exercise
1 dyspnea when walking up an incline or hurrying on the level
3 stops after a few minutes of walking on the level

The initial approach to evaluation begins by assessment of the airway, breathing, and circulation followed by a medical history and physical examination.[2] Signs that represent significant severity include hypotension, hypoxemia, tracheal deviation, altered mental status, unstable dysrhythmia, stridor, intercostal indrawing, cyanosis, tripod positioning, pronounced use of accessory muscles (sternocleidomastoid, scalenes) and absent breath sounds.[11]

A number of scales may be used to quantify the degree of shortness of breath.[17] It may be subjectively rated on a scale from 1 to 10 with descriptors associated with the number (The Modified Borg Scale).[17] Alternatively a scale such as the MRC breathlessness scale might be used – it suggests five grades of dyspnea based on the circumstances in which it arises.[18]

Blood tests[edit]



A chest x-ray is useful to confirm or rule out a pneumothorax, pulmonary edema, or pneumonia.[13] Spiral computed tomography with intravenous radiocontrast is the imaging study of choice to evaluate for pulmonary embolism.[13]




Individuals can benefit from a variety of physical therapy interventions.[20] Persons with neurological/neuromuscular abnormalities may have breathing difficulties due to weak or paralyzed intercostal, abdominal and/or other muscles needed for ventilation.[21] Some physical therapy interventions for this population include active assisted cough techniques,[22] volume augmentation such as breath stacking,[23] education about body position and ventilation patterns[24] and movement strategies to facilitate breathing.[23]


Along with the measure above, systemic immediate release opioids are beneficial in emergently reducing the symptom of shortness of breath due to both cancer and non cancer causes;[3][25] long-acting/sustained-release opioids are also used to prevent/continue treatment of dyspnea in palliative setting. There is a lack of evidence to recommend midazolam, nebulised opioids, the use of gas mixtures, or cognitive-behavioral therapy.[26]


Shortness of breath is the primary reason 3.5% of people present to the emergency department in the United States. Of these approximately 51% are admitted to hospital and 13% are dead within a year.[27] Some studies have suggested that up to 27% of people suffer from dyspnea,[28] while in dying patients 75% will experience it.[16] Acute shortness of breath is the most common reason people requiring palliative care visit an emergency department.[3]

Etymology and pronunciation[edit]

English dyspnea comes from Latin dyspnoea, from Greek dyspnoia, from dyspnoos, which literally means "disordered breathing".[11] Its combining forms (dys- + -pnea) are familiar from other medical words, such as dysfunction (dys- + function) and apnea (a- + -pnea). The most common pronunciation in medical English is /dɪspˈnə/ (disp-NEE), with the p expressed and the stress on the /niː/ syllable. But pronunciations with a silent p in pn (as also in pneumo-) are common,[29] as are those with the stress on the first syllable[29] (thus /dɪsˈniə/, /ˈdɪspniə/, or /ˈdɪsniə/).

See also[edit]


  1. ^ Donald A. Mahler; Denis E. O'Donnell (20 January 2014). Dyspnea: Mechanisms, Measurement, and Managemen, Third Edition. CRC Press. p. 3. ISBN 978-1-4822-0869-6. 
  3. ^ a b c d e Schrijvers D, van Fraeyenhove F (2010). "Emergencies in palliative care". Cancer J 16 (5): 514–20. doi:10.1097/PPO.0b013e3181f28a8d. PMID 20890149. 
  4. ^ Mukerji, Vaskar (1990). "11". Dyspnea, Orthopnea, and Paroxysmal Nocturnal Dyspnea. Butterworth Publishers. Retrieved 15 August 2014. In addition, dyspnea may occur in febrile and hypoxic states and in association with some psychiatric conditions such as anxiety and panic disorder. 
  5. ^ a b c d e f g h Zuberi, T.; et al. (2009). "Acute breathlessness in adults". InnovAiT 2 (5): 307–15. doi:10.1093/innovait/inp055. 
  6. ^ American Heart Society (1999). "Dyspnea mechanisms, assessment, and management: a consensus statement". Am Rev Resp Crit Care Med 159: 321–340. doi:10.1164/ajrccm.159.1.ats898. 
  8. ^ a b "UpToDate Inc.". 
  9. ^ "dyspnea – General Practice Notebook". 
  10. ^ a b c Frownfelter, Donna; Dean, Elizabeth (2006). "8". In Willy E. Hammon III. Cardiovascular and Pulmonary Physical Therapy 4. Mosby Elsevier. p. 139. 
  11. ^ a b c d e f Sarkar S, Amelung PJ (September 2006). "Evaluation of the dyspneic patient in the office". Prim. Care 33 (3): 643–57. doi:10.1016/j.pop.2006.06.007. PMID 17088153. 
  12. ^ http://en.diagnosispro.com/differential_diagnosis-for/poisoning-specific-agent-dyspnea/25103-154-100.html
  13. ^ a b c d e f g h i j k Torres M, Moayedi S (May 2007). "Evaluation of the acutely dyspneic elderly patient". Clin. Geriatr. Med. 23 (2): 307–25, vi. doi:10.1016/j.cger.2007.01.007. PMID 17462519. 
  14. ^ "How Is Asthma Treated and Controlled?". 
  15. ^ a b c d e Wills CP, Young M, White DW (February 2010). "Pitfalls in the evaluation of shortness of breath". Emerg. Med. Clin. North Am. 28 (1): 163–81, ix. doi:10.1016/j.emc.2009.09.011. PMID 19945605. 
  16. ^ a b c d Harrison's Principles of Internal Medicine (Kasper DL, Fauci AS, Longo DL, et al. (eds)) (16th ed.). New York: McGraw-Hill.
  17. ^ a b Saracino A (October 2007). "Review of dyspnoea quantification in the emergency department: is a rating scale for breathlessness suitable for use as an admission prediction tool?". Emerg Med Australas 19 (5): 394–404. doi:10.1111/j.1742-6723.2007.00999.x. PMID 17919211. 
  18. ^ Stenton C (2008). "The MRC breathless scale". Occup Med 58 (3): 226–7. doi:10.1093/occmed/kqm162. PMID 18441368. 
  19. ^ Abernethy AP; McDonald CF; Frith PA; et al. (September 2010). "Effect of palliative oxygen versus medical (room) air in relieving breathlessness in patients with refractory dyspnea: a double-blind randomized controlled trial". Lancet 376 (9743): 784–93. doi:10.1016/S0140-6736(10)61115-4. PMC 2962424. PMID 20816546. 
  21. ^ Frownfelter, Donna; Dean, Elizabeth (2006). "22". In Donna Frownfelter and Mary Massery. Cardiovascular and Pulmonary Physical Therapy 4. Mosby Elsevier. p. 368. 
  22. ^ Frownfelter, Donna; Dean, Elizabeth (2006). "22". In Donna Frownfelter and Mary Massery. Cardiovascular and Pulmonary Physical Therapy 4. Mosby Elsevier. pp. 368–371. 
  23. ^ a b Frownfelter, Donna; Dean, Elizabeth (2006). "32". Cardiovascular and Pulmonary Physical Therapy 4. Mosby Elsevier. pp. 569–581. 
  24. ^ Frownfelter, Donna; Dean, Elizabeth (2006). "23". In Donna Frownfelter and Mary Massery. Cardiovascular and Pulmonary Physical Therapy 4. Mosby Elsevier. 
  26. ^ DiSalvo, WM.; Joyce, MM.; Tyson, LB.; Culkin, AE.; Mackay, K. (Apr 2008). "Putting evidence into practice: evidence-based interventions for cancer-related dyspnea" (PDF). Clin J Oncol Nurs 12 (2): 341–52. doi:10.1188/08.CJON.341-352. PMID 18390468. 

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