Why You Feel Short of Breath — A Physician Explains Breathlessness
• Shortness of breath is a distressing and common symptom
• It can range from mild awareness of breathing to severe air hunger
• Breathlessness may arise from lungs, heart, blood, muscles, or anxiety
• Early understanding helps prevent panic and delayed diagnosis
General Readers
You may notice breathlessness when:
• Climbing stairs
• Walking faster than usual
• Lying flat
• Experiencing stress or panic
• Recovering from illness
Common non-serious causes:
• Deconditioning
• Anxiety or panic attacks
• Obesity
• Poor posture
• Mild anemia
Medical Students
Key causes to remember:
• Respiratory
• Asthma
• COPD
• Interstitial lung disease
• Cardiac
• Heart failure
• Ischemic heart disease
• Hematological
• Anemia
• Metabolic
• Acidosis
• Psychogenic
• Hyperventilation syndrome
Important distinction:
• Acute vs chronic dyspnea
Young Doctors
Clinical approach:
• Assess onset:
• Sudden → consider PE, pneumothorax
• Gradual → chronic disease
• Evaluate severity:
• Rest vs exertion
• Look for associated symptoms:
• Chest pain
• Cough
• Wheezing
• Edema
Basic evaluation:
• Pulse oximetry
• Chest examination
• ECG
• Chest X-ray if indicated
General Practitioners
Common presentations in practice:
• Post-viral breathlessness
• Asthma exacerbations
• Anxiety-related dyspnea
• Anemia in elderly or women
• Early heart failure
Management principles:
• Identify reversible causes
• Avoid dismissing symptoms
• Reassure when appropriate
• Refer early if red flags present
Pathophysiology
Mechanisms leading to breathlessness:
• Impaired oxygen exchange
• Reduced cardiac output
• Increased respiratory drive
• Muscle fatigue
• Blood oxygen-carrying deficiency
• Central perception of air hunger
Breathlessness often reflects mismatch between demand and supply.
When to See the Doctor
Seek urgent care if breathlessness:
• Occurs at rest
• Is sudden and severe
• Is associated with:
• Chest pain
• Bluish lips
• Dizziness or fainting
• Swelling of legs
• Worsens progressively
Breathlessness should never be ignored. While many causes are benign and reversible, some are life-threatening. Timely evaluation, reassurance, and appropriate treatment restore both breathing and confidence.
Dos and Don’ts
DO
• Sit upright during episodes
• Practice slow breathing
• Maintain physical fitness
• Manage weight
• Take prescribed inhalers correctly
DON’T
• Panic
• Ignore sudden breathlessness
• Overuse rescue inhalers
• Delay medical evaluation
• Assume anxiety is the only cause
FAQs
• Can anxiety cause breathlessness?
• Yes, very commonly
• Is breathlessness always lung-related?
• No, heart and blood causes are common
• Can anemia cause shortness of breath?
• Yes, especially on exertion
• Should I exercise if I get breathless?
• Yes, but gradually and under guidance
• Is breathlessness after COVID normal?
• It can persist and needs evaluation
By Dr. Mohammed Tanweer Khan
A Proactive/Holistic Physician
Founder of WithinTheBody.com