Shortness of Breath: Causes, Diagnosis, and Treatment Options

Medically Reviewed by Dr. Oluwakemi Balogun (Kemi), MD — Medhaven Health

Last updated: September 2025

Shortness of breath, or dyspnea, is a common and often alarming symptom that can significantly affect quality of life. It is characterized by an uncomfortable awareness of breathing or the sensation of not getting enough air. While it can be triggered by something as benign as vigorous exercise, it may also indicate an underlying medical condition that requires urgent attention.

This article will explore the various causes of shortness of breath, the diagnostic approach clinicians use, and treatment options available depending on the cause. Whether you experience breathlessness occasionally or persistently, understanding the potential sources is essential to managing and improving your respiratory health.

What Is Shortness of Breath?

Shortness of breath, medically termed dyspnea, is defined as an uncomfortable awareness of breathing or the inability to get enough air. It may be acute (sudden and severe) or chronic (lasting weeks or longer), and can range from mild to life-threatening.

Key Symptoms Often Accompanying Dyspnea:

• Chest tightness

• Wheezing

• Cough

• Rapid breathing

• Fatigue

• Dizziness or lightheadedness

Common Causes of Shortness of Breath

Shortness of breath can stem from multiple systems of the body—primarily the lungs, heart, muscles, and nervous system. It is important to evaluate the context, onset, and accompanying symptoms to determine the likely cause.

1. Pulmonary (Lung-Related) Causes

A. Asthma

• Chronic inflammatory disease of the airways.

• Causes wheezing, chest tightness, and shortness of breath, especially at night or after exercise.

• Triggered by allergens, cold air, smoke, or stress.

B. Chronic Obstructive Pulmonary Disease (COPD)

• Includes emphysema and chronic bronchitis.

• Common in smokers or those with prolonged exposure to pollutants.

• Symptoms: persistent cough, mucus production, breathlessness, and frequent respiratory infections.

C. Pneumonia

• Lung infection causing inflammation and fluid accumulation in air sacs.

• Symptoms: fever, chills, productive cough, fatigue, and dyspnea.

D. Pulmonary Embolism (PE)

• Life-threatening condition caused by a blood clot in the lungs.

• Symptoms: sudden sharp chest pain, rapid heartbeat, fainting, and breathlessness.

• Requires emergency treatment.

E. Interstitial Lung Disease (ILD)

• A group of disorders causing lung scarring.

• Leads to progressive shortness of breath and dry cough.

F. COVID-19 and Post-COVID Syndrome

• Acute infection can cause significant lung inflammation.

• Long-COVID may result in persistent dyspnea and fatigue months after infection.

2. Cardiac (Heart-Related) Causes

A. Congestive Heart Failure (CHF)

• The heart is unable to pump blood efficiently, leading to fluid buildup in the lungs.

• Symptoms: breathlessness when lying down (orthopnea), leg swelling, fatigue, and cough.

B. Myocardial Infarction (Heart Attack)

• Sudden blockage of coronary arteries.

• Can cause acute dyspnea, chest pressure, nausea, and sweating.

C. Arrhythmias

• Irregular heartbeats can reduce oxygen delivery, leading to breathlessness and palpitations.

D. Valvular Heart Disease

• Malfunctioning heart valves impair blood flow and pressure, resulting in dyspnea on exertion or even at rest.

3. Hematologic and Metabolic Causes

A. Anemia

• Low red blood cell count or hemoglobin reduces oxygen delivery to tissues.

• May present with fatigue, pallor, and breathlessness with exertion.

B. Acidosis or Metabolic Disorders

• Abnormalities in pH can stimulate breathing as a compensatory mechanism.

4. Neuromuscular and Anxiety-Related Causes

A. Anxiety and Panic Attacks

• May present with a sensation of suffocating, rapid breathing, chest tightness, and dizziness.

B. Obesity and Deconditioning

• Excess weight can physically restrict lung expansion.

• Poor fitness levels reduce the body’s oxygen efficiency, especially during activity.

C. Neuromuscular Disorders

• Conditions like ALS or muscular dystrophy weaken the muscles involved in breathing.

When to Seek Immediate Medical Attention

Call 911 or go to the emergency room if shortness of breath is:

• Sudden and severe

• Associated with chest pain or pressure

• Accompanied by bluish lips or face

• Followed by fainting or confusion

• Occurring with rapid heartbeat and sweating

Diagnostic Evaluation of Dyspnea

A thorough work-up is needed to identify the underlying cause. This may include:

1. Medical History and Physical Examination

• Duration, triggers, position-related symptoms

• History of smoking, heart or lung disease

2. Blood Tests

• CBC to check for anemia or infection

• BNP for heart failure markers

• D-dimer for suspected blood clots

3. Imaging Studies

• Chest X-ray: To look for pneumonia, fluid, or masses

• CT scan: For pulmonary embolism or detailed lung assessment

4. Pulmonary Function Tests (PFTs)

• Measure lung capacity and airflow (useful for asthma, COPD)

5. Echocardiogram

• Ultrasound of the heart to evaluate pumping ability and valves

6. Pulse Oximetry and Arterial Blood Gases (ABG)

• Assess blood oxygen levels and respiratory function

Treatment Options Based on the Cause

Pulmonary Causes

• Asthma/COPD: Bronchodilators (albuterol), inhaled corticosteroids, lifestyle changes (quit smoking), and pulmonary rehab.

• Pneumonia: Antibiotics or antivirals; oxygen therapy in severe cases.

• Pulmonary Embolism: Anticoagulants, thrombolytics, and hospitalization.

• ILD: Anti-fibrotic agents, oxygen therapy, corticosteroids.

Cardiac Causes

• Heart Failure: Diuretics (to reduce fluid), ACE inhibitors, beta-blockers, low-sodium diet.

• Arrhythmias: Anti-arrhythmic medications, ablation, or pacemaker.

• Heart Attack: Emergency treatment with aspirin, angioplasty, or surgery.

• Valvular Disorders: May require valve repair or replacement.

Other Causes

• Anemia: Iron supplements, B12 or folate if deficient, or blood transfusion in severe cases.

• Panic Disorder: Breathing exercises, CBT, SSRIs (medication).

• Obesity: Weight loss interventions, CPAP if obstructive sleep apnea is present.

Preventing Shortness of Breath

• Quit smoking and avoid secondhand smoke

• Exercise regularly to maintain cardiovascular and pulmonary health

• Manage chronic conditions like diabetes, asthma, and high blood pressure

• Get annual flu shots and pneumonia vaccines

• Avoid known allergens or pollutants

• Maintain a healthy weight

• Reduce anxiety with meditation, counseling, or therapy

Q&A: Common Patient Questions

Q: I only get short of breath when I exercise. Is that normal?

A: Mild shortness of breath is expected during physical activity, but if it’s new, worsening, or disproportionate to your activity level, it’s important to be evaluated.

Q: Can anxiety really cause shortness of breath?

A: Yes. Anxiety can lead to rapid, shallow breathing and a sensation of suffocation, which can mimic serious medical conditions.

Q: What’s the best way to tell if it’s my heart or lungs causing it?

A: It’s not always easy to tell based on symptoms alone. Chest imaging, EKG, and echocardiograms are helpful in identifying the source.

Conclusion: Don’t Ignore Shortness of Breath

Shortness of breath is a symptom that should never be ignored, especially if it is persistent, worsening, or accompanied by other concerning signs. It may signal an underlying issue in the lungs, heart, blood, or even mental health.

At MedHaven Health, we specialize in evaluating and managing patients with respiratory and cardiovascular symptoms. Whether it’s asthma, heart failure, anxiety, or post-COVID complications, our experienced providers use a personalized approach to identify the cause and provide effective treatment options.