Difficulty in breathing


Dyspnoea, shortness of breath, breathlessness are synonymous.


We have to breath to stay alive. We breath even when we sleep! Normally we are not aware of the act of breathing.


Awareness of breathing is called dyspnoea.


There are many causes of shortness of breath:


Acute or sudden onset breathlessness (in minutes) –

Anxiety – panic attack - respiratory alkalosis, carpo-pedal spasm, pins and needles.

Foreign body – choking

Anaphylaxis – eg peanut allergy

Pneumothorax – air around a lung

Pulmonary embolism – clot in the lung - pleuritic chest pain, cyanosis, haemoptysis.


Subacute breathlessness (in hours) -

Left ventricular failure (pulmonary oedema) - orhtopnoea, pink frothy sputum, basal crackles.

Asthma - wheezes.

Exacerbation of COPD - wheezing may be present, reduced breath sounds.

Chest infection - fever, cough, sputum.

Metabolic acidosis – eg diabetic ketoacidosis - acidotic breathing - deep sighing respiration.


Chronic breathlessness (in days-weeks) –

Anaemia - reduced oxygen-carrying capacity

Recurrent small Pulmonari emboli

Cardiac failure - oedema, engorged neck veins, enlarged tender liver.

COPD - hyperinflated chest, reduced air entry.

Bronchiectasis - clubbing, coarse basal crackles.

Chest infection - fever, cough, sputum.

Pleural effusion - fluid around lungs - reduced air entry with dullness on percussion.

Pulmonary fibrosis

Pulmonary hypertension

Lung cancer - chest pain, haemoptysis, clubbing, weight loss.

Chest wall deformity

Neuromuscular disease - eg Myasthenia gravis