This brief post is about a worrisome symptom: shortness of breath, also known as “dyspnea.”
Not being able to breathe tops all other fears (save perhaps public speaking). Being short of breath can be caused by something as simple as a cold or a faceful of dust, or being deconditioned… or the sign of something more concerning, such as asthma, heart failure, even cancer.
So let’s go through a step-by-step evaluation.
If you feel short of breath and have a low fever, you may have a cold. Many colds start slowly, often with a sore throat for a day or so and then progress to cough, facial and chest congestion, runny nose, body aches. Colds are caused by viruses, which do not respond to antibiotics, but you may get symptom control with over-the-counter cold medicines. Your cold may progress further to bronchitis, an irritated lung, but that is still not a lung infection. A healthy immune system usually takes care of these kinds of minor infections in 7-10 days, though you may have a few weeks of persistent cough afterwards as yoru body processes the extra secretions (phlegm) your body created to fight off the cold. Not unusual, just annoying, and overall you feel better.
If your symptoms go on for more than 10 days, or suddenly take a turn for the worse, you may have developed a lung infection (pneumonia), which may need to be treated. Longer infections should be evaluated by your doctor.
If your symptoms come on suddenly (and you did NOT get your flu shot), you may have influenza (the flu), also a viral illness. If you’re seen within the first 48 hours of onset, you may benefit from anti-viral treatment, but after that, you treat as you would a cold: rest, fluids and supportive care. No antibiotics.
Being short of breath without infection may have many causes. Sudden onset dyspnea may be a blood clot to the lung, an abscess, puncture to the lung or pleurisy, depending on other health problems you may have, your medications (or forgetting them) or other risks, such as smoking. Dyspnea caused by hyperventilation, such as during a panic attack, can even contribute to chest pain, hand tingling and numbness around the mouth. All should be evaluated by your doctor.
Ongoing shortness of breath, with or without wheezing or cough may be a sign of asthma or anemia or heart failure and are easily evaluated by your doctor. If you are a heart failure patient with increasing shortness of breath, ankle swelling or sudden weight gain (in 1-3 days), your heart failure may be poorly controlled. Each of these conditions are treatable causes of dyspnea, that left untreated can be problematic—even deadly–over time.
Finally, and more rarely, lung cancer is a cause of shortness of breath, but lung cancer may not present as shortness of breath until late in the disease. A persistent cough, hoarse voice, phlegm with blood in it, progressive fatigue or unexpected weight loss may present sooner, especially in at-risk people such as smokers, those who live with smokers or those exposed to smoke or chemicals. Regular check-ups, especially if you are at risk, will help catch problems early.
Shortness of breath is a sign your body is giving you that something needs attention! Keeping your body healthy (proper diet, regular exercise, avoiding smoking, washing your hands!) protects you from illness—nearly free!
Be well!

Dr Hoffman

Dr. Rebecca Hoffman is a Family Practitioner and works at Kaiser Permanente in Salmon Creek, which is in Vancouver, Washington. Interests include using diet and healthy living to stay healthy and attending to mental health and its physical manifestations. Personal interests include hiking, jogging, music (she plays the harp), dance, theater, storytelling and writing. She lives with her husband and two daughters.

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