Breath Shortness Of

WHEN TO SEE YOUR DOCTOR

* You're short of breath but cannot breathe more rapidly to compensate.

* You also have chest pain, swollen feet or legs or a history of heart problems.

* You have not been previously diagnosed with asthma or another breathing disorder.

* Shortness of breath is accompanied by wheezing, rapid breathing or coughing up phlegm.

What Your Symptom Is Telling You

Being a little winded is entirely natural and harmless if you've exerted yourself. The shortness of breath simply reflects the increased oxygen demand that you've placed on your body. But there's a difference between a brisk walk around the block and walking upstairs.

If you pant at the top of the stairs, it could simply mean that you're unfit, says Henry Gong, Jr., M.D., a professor of medicine in the Pulmonary Division of the University of California at Los Angeles Medical Center. But it could also mean that you're unwell.

A person could be short of breath because of any number of lung problems. Any lung infection—from a mild cold or case of bronchitis to pneumonia and tuberculosis—can turn breathing into a chore.

Three chronic respiratory diseases—asthma, chronic bronchitis and emphysema—all cause shortness of breath and frequently, wheezing.

A collapsed lung—a problem in people with emphysema and other lung diseases and (for reasons not understood) in tall, young men—is another cause of shortness of breath. In addition to feeling a sudden onset of shortness of breath, a person with a collapsed lung will probably also feel pain on the affected side of the chest, Dr. Gong says.

In several serious neurologic conditions—multiple sclerosis, Lou Gehrig's disease and myasthenia gravis—a person gradually loses the ability to breathe because of progressive muscle weakening, says Michael S. Sherman, M.D., an assistant professor and medical director of the Department of Pulmonary Services in the Division of Allergy, Critical Care and Pulmonary Medicine at Hahneman University Hospital in Philadelphia.

But there are also a couple of emergency situations that can produce sudden, severe shortness of breath. Botulism (a rare but potentially fatal form of food poisoning) and lead poisoning both block messages from the nervous system to the breathing muscles, leaving a person unable to breathe more deeply even though they feel it is necessary, according to Mark J. Rumbak, M.D., an assistant professor of pulmonary medicine at the University of South Florida College of Medicine in Tampa.

Symptom Relief

Relief for shortness of breath typically involves helping you get the most use out of your available lung capacity with exercises, drugs or surgery. Asthma is often reversible, doctors say, and most other conditions are at least treatable to some extent. Here are a few things you should be aware of.

Nix the sticks. Cigarette smoking causes many of the conditions that lead to shortness of breath. It goes without saying, but don't smoke. Talk to your doctor about quitting. He can recommend medication or a stop-smoking program.

Be fit to breathe. If you're overweight or sedentary, all you may need to eliminate your shortness of breath is a fitness program to get your heart and lungs in better condition, Dr. Gong says. Brisk walking is a good choice. Your goal should be a minimum of 20 minutes of brisk walking three times a week.

Breathe from your belly. Abdominal breathing with your diaphragm uses more lung capacity more efficiently, enabling you to breathe deeply instead of rapidly, Dr. Sherman says. Inhale through your nose and allow your stomach, not your upper chest, to move outward. That permits air to reach to the bottoms of your lungs, filling them completely.

Kiss the air. People with cardiopulmonary problems can breathe better if they exhale through pursed lips, Dr. Sherman says. Just pucker up after inhaling and slowly let the air out from your mouth, not your nose.

Be the Arnold Schwarzenegger of air. Increase the strength of your diaphragm and other muscles used in breathing with the help of a resister—a device that is available through either your doctor or medical supply stores. "There are several on the market. Some look like a kazoo with an adjustable hole in one end," Dr. Sherman says. You perform several sets of breathing exercises through the resister every day. In succeeding weeks, you increase the resistance, which forces your diaphragm and other breathing muscles to work harder. "That increases the strength of your diaphragm, and you may be able to breathe more powerfully. However, the effectiveness of these devices is controversial," he says.

Inhale before you exercise. Even if strenuous exercise causes exercise-induced asthma, you don't have to shy away from physical fitness, says Susan R. Wynn, M.D., an allergist in private practice with Fort Worth Allergy and Asthma Associates in Texas. Take a couple of draws on your bronchodilator about 20 minutes before working out, and make sure you warm up for at least ten minutes.

Take the plunge. For anyone troubled by shortness of breath, but particularly for people with asthma, swimming is an ideal exercise, according to Dr. Wynn. "You're breathing humid air, which is easier on your lungs," she explains.

Prop up your bed. If breathing is impaired when you lie down at night, put several books beneath the legs of your bed's headboard, raising it between 30 and 45 degrees, Dr. Sherman says. You also could purchase a foam wedge to lie on from a medical supply store.

Consider medications. Doctors treat asthma with corticosteroids to reduce lung inflammation. For asthma and many other respiratory conditions, doctors also prescribe bronchodilators—oral medications and inhaled sprays that help to open airways. "Some patients with severe asthma may benefit from receiving bronchodilators using a home nebulizer," says Dr. Sherman.

Get treatment for a collapsed lung. If only a small area of the lung has collapsed, it may reinflate on its own. Usually, though, doctors have to quite literally inflate it like a balloon with oxygen treatments or insert a needle into the chest to suck out the air pocket compressing the lung.

Breathe in unison. Pulmonary rehabilitation programs allow you to interact with other people who share your lung problems, while at the same time teaching you a variety of breathing and relaxation therapies to make your life easier, Dr. Gong says. Call a hospital or the local chapter of the American Lung Association for more information.

See also Wheezing