Breathing problems include pain, discomfort or any difficulty that interferes with the natural cycle of inhaling and exhaling air.

Breathing problems are common symptoms caused by many conditions, including asthma, chronic obstructive pulmonary disease (COPD), other lung diseases and heart disease. Most people who have breathing problems are aware of the condition, such as when children struggle to catch their breath during an asthma attack or ex-smokers find themselves easily winded due to emphysema.

However, some breathing problems are difficult or impossible to detect without a medical evaluation. An evaluation will usually include a detailed history on the pattern and circumstances surrounding the breathing difficulty and may also involve medical tests.

A breathing problem stemming from a disease or a condition may be treated with medication that targets the underlying cause. For instance, asthma-related breathing disorders may be treated with bronchodilators, while people with emphysema may be given oxygen.

People whose breathing problems are caused by allergies should avoid potential allergens, such as pollens, dust and molds. In all cases, people with breathing problems are advised to avoid smoking and follow a healthy lifestyle that includes a good diet and maintaining a healthy weight.

An individual who experiences unusual difficulty in breathing should seek the immediate advice of a physician.

Breathing problems include any condition that changes the normal pattern of inhaling oxygen and exhaling carbon dioxide that is necessary for a person to sustain life.

As a person inhales, oxygen enters the lungs. The air is then transported by red blood cells and distributed throughout the body. Red blood cells exchange fresh oxygen for carbon dioxide, which is a waste product, and transports this waste gas to the lungs to be expelled when the person exhales.

An average adult breathes approximately 15 to 20 times per minute while at rest. When this process works efficiently, most people are not even aware of it. But when something interferes with normal breathing patterns, the symptoms usually are noticeable. These may include shortness of breath, wheezing or a chronic cough.

Some breathing problems can be considered normal, such as the impaired nasal breathing that accompanies nasal congestion during a common cold, or breathlessness after strenuous exercise. However, many breathing problems indicate a serious underlying illness or condition and demand prompt medical attention.

The most serious breathing problem is apnea, which occurs when spontaneous breathing stops for any reason. Sometimes apnea is temporary or starts and stops at intervals, such as during sleep apnea (episodic breathing failure during sleep). Other forms of breathing cessation last for longer periods and are known as prolonged apnea, or even respiratory arrest. This is a life-threatening disorder that demands emergency medical attention.

People who experience apnea that lasts any duration should consult a physician. Even temporary apnea can have a significant impact on health. Patients may turn blue, experience seizures, become drowsy, remain unconscious or go limp.

Breathing problems include any symptom or condition that affects the function of the respiratory system. They can take many forms, including:

• Shortness of breath. A feeling of not getting enough air, which may leave a person gasping. It is also known as dyspnea.
  
  
• Wheezing. A whistling or high-pitched sound that results when breathing tubes are narrowed (or constricted) or obstructed.
  
  
• Apnea. Spontaneous breathing that stops for any reason. It may be temporary (starting and stopping at intervals) or prolonged.
  
  
• Respiratory arrest. A life-threatening disorder that requires emergency medical attention. It is the result of excessive loss of oxygen or excessive increase of carbon dioxide in the blood.
  
  
• Hyperventilation. Respiration faster than the body requires. It results in an excessive loss of carbon dioxide from the body.
  
  
• Coughing. A forceful movement of air that clears material from the airway, but often causes discomfort. It sometimes is accompanied by shortness of breath, chest pain and other symptoms.
  
  
• Stridor. A crowing sound audible during inhalation that is the result of blockage in the throat (pharynx), voice box (larynx) or windpipe (trachea). It often is loud enough to be heard from a distance and can indicate a life-threatening emergency.
  
  
• Cyanosis. A bluish discoloration of the skin that results when blood in the body lacks the proper oxygen content and turns bluish as a result. Many conditions that affect the lungs, blood vessels and heart can cause cyanosis.
  
  
• Cardiac asthma. A cluster of breathing problems (e.g., shortness of breath, coughing, wheezing) that is one of the first signs of heart failure. It begins when the left ventricle of the heart is unable to handle the blood flow being pumped by the right ventricle. It is not actually asthma, but mimics the symptoms of that condition.

There are many potential sources of breathing problems, some minor and others more significant. Sometimes, simple anxiety can lead to difficulty breathing, such as during a panic attack. Other times, the cause is more serious, such as heart failure.

Any obstruction of the nose, mouth or throat can cause breathing problems. Injuries, diseases and toxins also can interfere with normal respiration.

Common causes of breathing problems include:

• Asthma. A condition where airways constrict, making breathing difficult.

• Emphysema.  An enlargement of the tiny air sacs of the lungs (alveoli) and deterioration of their  walls.
  
  
• Bronchitis. Inflammation of the airways (bronchial tubes). Breathing problems may occur in both acute bronchitis and chronic bronchitis.
  
  
• Chronic obstructive pulmonary disease (COPD). Continuous obstruction of the airways caused by emphysema or chronic bronchitis.
  
  
• Coronary artery disease. A disease in which blood flow is obstructed through the coronary arteries that supply the heart with oxygen-rich blood.
  
  
• Croup. A common respiratory illness that involves inflammation of the voice box (larynx) and windpipe (trachea). The condition primarily affects infants and young children.
  
  
• Deconditioning. The medical term for lack of exercise that contributes to poor lung function. Lack of exercise is also often associated with obesity, which is a condition that can further deteriorate lung function.
  
  
• Heart arrhythmia. An abnormal heartbeat that may be unusually fast or unusually slow.
  
  
• Heart attack (myocardial infarction). A condition where blood supply is partially cut off from the heart, leading to the death of heart muscle (myocardium) from lack of oxygen.
  
  
• Heart failure. A condition in which the heart is unable to pump enough blood to meet the body's demands. This leads to congestion within the blood vessels and may cause fluid backup and swelling (edema) in the lungs, legs and ankles.
  
  
• Interstitial lung disease. A category of chronic lung disorders characterized by scarring and inflammation.
  
  
• Medication side effects. Unintended side effect of some heart medications, such as beta blockers.
  
  
• Pneumothorax (or “collapsed lung”). A pocket of air between the two layers of the pleura, the thin membrane that covers the interior chest wall and the lungs.
  
  
• Pulmonary embolism. A sudden blocking of an artery of the lung, usually due to a blood clot.
  
  
• Pulmonary edema. A build-up of fluid in the lungs that results when the heart does not pump adequately.
  
  
• Pulmonary hypertension. Characterized by high blood pressure (hypertension) in the blood vessels that supply oxygen-poor blood to the lungs.
  
  
• Sleep apnea. A group of disorders in which a person periodically stops breathing during sleep, decreasing oxygen and increasing carbon dioxide in the blood.
  
  
• Whooping cough. A contagious disease in which a dry cough worsens over time, producing a “whooping” sound. Other symptoms include fever, runny nose, sneezing and possible vomiting. A vaccine is available.

Other potential triggers for breathing problems include:

• Allergic reaction
  
  
• Other forms of heart disease
  
  
• Digestive conditions (such as gastroesophageal reflux disease)
  
  
• Injuries to the chest, neck or lungs
  
  
• Tobacco smoke
  
  
• Dust and other workplace irritants (e.g., chemicals, solvents, paints)
  
  
• Pneumonia
  
  
• Drug overdose
  
  
• High altitude
  
  
• Obesity
  
  
• Airway obstruction or choking
  
  
• Seizures
  
  
• Metabolic disorders (such as anemia)
  
  
• Compression of the chest wall

Air pollution is often responsible for worsening respiratory conditions and causing breathing problems, particularly in metropolitan areas. In particular, air pollution has been linked to an increased risk of asthma and allergies, particularly in unborn children.

Because so many different conditions can trigger breathing problems, the symptoms also are varied. Individuals should promptly consult with a physician after experiencing any of the following symptoms:

• Unexplained shortness of breath
  
  
• Wheezing (a whistling or high-pitched sound when breathing)
  
  
• Shortness of breath after mild activity
  
  
• Dizziness or confusion
  
  
• Waking up short of breath, or using extra pillows to prop up the head as a means of avoiding shortness of breath
  
  
• Barking, croupy cough or tightness in the throat
  
  
• Hyperventilation (breathing more than the body needs)
  
  
• Significant or continuous cough
  
  
• Fever associated with breathing problems
  
  
• Gurgling sounds coming from the chest

Immediate medical attention should be sought when breathing problems seriously interfere with breathing or when breathing completely stops. Individuals should also seek emergency medical attention when breathing problems are accompanied by:

• Chest pain
  
• Sweating
  
• Nausea or vomiting
  
• Bluish lips and fingernails (cyanosis)
  
• Inability to speak
  
• Swelling of the face, tongue or throat
  
• Hives
  
• Rapid or irregular heartbeat
  
• Coughing up large amounts of blood
  
• Excessive drooling

Several methods can be used to accurately diagnose the source of a breathing problem. A physician will perform a physical exam, including a careful examination of the lungs, heart and upper-airway passages.  The physician will also collect the patient’s medical history, including current medications, and inquire about the details of the breathing problem. Questions a physician may ask will often involve the following:

Breathing quality

• Do you notice shortness of breath?
• Do you make grunting sounds while breathing?
• Do you have to work hard to breathe?

Time pattern

• What is the duration of breathing problems (months or years)?
  
  
• Did the breathing problems begin recently or suddenly?
  
  
• Do the breathing problems develop gradually and have they worsened recently?
  
  
• What is the length of time that breathing problems last?
  
  
• Does each repeated episode follow the same pattern and does the level of the problem change?
  
  
• Does the breathing problem cause loss of sleep (paroxysmal nocturnal dyspnea)?

Aggravating factors

• Did breathing problems develop within 4 to 6 hours following exposure to a possible allergen (such as pollen or pet dander)?
  
  
• Does the breathing problem get worse with a change in body position?
  
  
• Does lying flat aggravate the problem (orthopnea)?
  
  
• Does exercise aggravate the problem?
  
  
• Is wheezing associated with shortness of breath?

Diagnostic tests also can help pinpoint the nature of the problem. Such tests include:

• Pulmonary function test. Reveals how much air is in the lungs and how quickly it is exhaled.
  
  
• Spirometry. Measures how much air a person blows out in a fixed period of time, and how forcefully it is blown. It also can reveal the extent of airway obstruction present.
  
  
• Arterial blood gas analysis. Measures concentrations of oxygen and carbon dioxide present in a blood sample taken from an artery.
  
  
• Echocardiogram. Uses sound waves to create a picture of the heart.
  
  
• Chest x-ray. Uses low doses of radiation to produce an image of the chest.
  
  
• Electrocardiogram (EKG). Records the electrical activity of the heart.
  
  
• Stress test. Takes EKG readings of the heart while a person exercises.
  
  
• CAT scan of the chest. Creates a picture of the chest and upper abdomen.
  
  
• Sputum culture. Checks for the presence of bacteria in coughed-up mucus.

If an individual is suffering from severe, acute breathing problems and needs emergency help, take the following steps:

1. Dial 9-1-1 immediately
   
   
2. Check the person’s airway, breathing and circulation and begin rescue breathing or CPR if necessary
   
   
3. Loosen tight clothing
   
   
4. Help the person use a prescribed inhaler, oxygen or other medications
   
   
5. Monitor the person until help arrives
   
   
6. Bandage open wounds in the neck and chest immediately, especially if air bubbles appear in the wounds
   
   
7. Close open wounds in the chest cavity with a bandage to prevent air from getting in and causing a collapsed lung. Use a plastic wrap or gauze pads covered with petroleum jelly and seal it except for one corner (to allow trapped air to escape the chest). 

Once at the hospital, treatments will vary depending on the condition or other factor causing the breathing problem. For instance, asthma-related breathing disorders may be treated with bronchodilators while people with emphysema may be given oxygen.

If a breathing problem stems from a disease or a condition, the problem may best be treated with a medication that targets the underlying cause. For instance, asthma-related breathing disorders may be treated with bronchodilators while people with emphysema may be given oxygen.

However, a variety of techniques can be used to handle general breathing problems. These include:

• Pursed-lip breathing. Involves exhaling with lips partially closed, as if preparing to whistle. It is often used by individuals with chronic obstructive pulmonary disease (COPD) because it prevents over-inflation of the lungs by increasing pressure in the airways, keeping the lungs from collapsing.
  
  
• Diaphragmatic breathing (also known as “deep breathing” or “belly-breathing”) helps fill the lungs fully and slows the breathing rate, creating a sense of relaxation. This is important, because those with breathing problems can exacerbate the situation if they panic or become too anxious. To practice this method:
  
  
• 1. Place one hand just below the ribs and the other on the chest
  2. Inhale deeply, letting the belly push the hand out
  3. Exhale slowly through pursed lips
  4. Repeat three to 10 times
     
     
• Sitting breathing exercises:
  
  
• 1. Rest feet flat on the floor
  2. Lean chest forward slightly
  3. Rest elbows on knees and chin on hands
  4. Relax neck and shoulders
     
     OR

• 1. Rest feet flat on floor
  2. Lean chest forward slightly
  3. Rest arms on a table
  4. Rest head on forearms or pillows
     
     
• Standing breathing exercises:
  
  
• 1. Stand with feet shoulder–width apart
  2. Lean hips against a wall
  3. Rest hands on thighs
  4. Relax shoulders, lean forward slightly and dangle arms in front of body
     
     OR

• Sleeping positions:
  
  
• • Lie on side with one pillow between legs and another under head, keeping back straight
    
    
  • Lie on back with head elevated on pillows, knees bent and pillow beneath knees

Some breathing problems come on suddenly with little or no warning, while others are the result of diseases hidden in the body. It is difficult to prevent such problems from occurring. However, individuals can take steps to reduce the likelihood of encountering breathing problems, including:

• Avoiding tobacco smoke
  
  
• Exercising regularly
  
  
• Trying to avoid pollens, dust, molds and other allergens
  
  
• Maintaining a healthy diet
  
  
• Maintaining a healthy weight
  
  
• Washing hands frequently
  
  
• Receiving appropriate vaccines (e.g., pneumonia, whooping cough)
  
  
• Wearing a mask when working around dust, chemicals, solvents or paints

In addition, some medications may be prescribed to help a person prevent breathing problems associated with a condition, such as leukotriene modifiers (drugs that reduce airway inflammation) for asthma.

Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions related to breathing problems:

1. Do my symptoms indicate a breathing problem?
   
   
2. What tests will you use to determine the cause of my breathing problems?
   
   
3. Are my breathing problems temporary or will they persist?
   
   
4. What should I do if I am having trouble breathing?
   
   
5. Are there medications available that can help me to breathe better?
   
   
6. Are my breathing problems a symptom of a larger health issue?
   
   
7. When should I seek emergency medical attention for breathing problems?
   
   
8. Are there lifestyle changes I can make to prevent breathing problems?
   
   
9. What factors may aggravate my breathing problems?
   
   
10. What dangers do my breathing problems pose?